Hello,
I just wanted to check in and see what everyone is doing with PICC consents. We currently are doing 2,800 PICCs per year and have 3 nurses on days and evenings with one on nights. We made an excellent PICC video for staff to show patients and families so they can obtain consent. Our legal department is okay with this.
We are a Vascular Access Service. We do PICCs and peripheral IVs. We access and deaccess IP, cover 6 hospitals and run all day.
To add consents back into the mix, we won't get anything done. Is there research that shows the PICC nurse obtaining consent is best practice? Especially if we have a video that has us doing the talking. We always ask the patient or family if there are any questions before we begin. We also give every patient or family a flyer with frequently asked questions.
Any thoughts?
Julie
By "informed consent" are you referring to the patient's agreement after solid education about the procedure, risks, benefits, and alternatives OR are you referring to the signature on a piece of paper? The former is considered informed consent and the later is the final small step in the process. If you video is comprehensive to cover all aspects of informed consent, and you valid their understanding, I would think it is sufficient. But you can not just expect a patient to watch a video without any confirmation that they comprehend what is being done. Also, alternatives must be included. So check your video about that aspect. The person performing the procedure is the one responsible for assuring that the patient understands and accepts the procedure and obtains the signature. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
But who has to get the consent? Is it the PICC nurse or can RN staff get consent?
The person performing the procedure should be responsible for the entire process up to and including getting the piece of paper signed. The primary care nurse should not have this responsibility because they are not prepared to address all questions that could arise.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Lynn,
I just have a couple of questions about this.
If we would take the time to do this, we would be slowed down tremendously.
We do 2,800 PICCs per year. Many of our patients can't get their own consent and families must be called. The staff nurse already has a relationship with the family. Why isn't it her responsiblity?
If we have a video and a hand out that covers the material and we take the time when we do come to answer any and all questions, why can't she get the signature?
Do we really need the signature?
Thanks for your time.
Julie
Those are questions that should be discussed with your risk manager and facility attorney and decided as a team. Many risk managers are now saying that the signature on a piece of paper specific for a PICC insertion is not necessary. Their reasonsing that I have heard is that PICCs are now so prevalent that they are covered by the general consent signed on admission. This does not take the place of adequate education for the patient and family. The staff nurse should never be the one responsible for doing this education and obtaining the signature because they do not have the same knowledge and skill as you do. Should a surgeon delegate the responsibility for teaching about the surgical procedure to another nurse? Your teaching methods appear to be sound but the person responsible for performing the procedure is the one who obtains the signature with the primary care nurse witnessing that the signature is actually the correct patient. That is the extend of the primary care nurse's responsibility.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Due to the way our policy is written on consents, it required the physician to discuss the procedure and discuss insertion, risks, and alternatives. This wasn't happening at all. The physicians were not the ones with the information. (If we waited for that to happen, we would be crippled as a team responding to 5 hospitals and their requests and have so much more non-productive time.) We confessed to our legal department that we weren't following this policy and that we wanted to determine what was the best course of action to be in compliance.
We don't have written consents anymore. We do still educate about the insertion process and risks, etc. We consulted at length with our legal department about this and discussed with executive nursing management about it. We do want the patient's verbal agreement to proceed with the PICC. If not, we don't do it.
No problems for us since we started this almost a year ago. We do over 3500/year.
Gwen Irwin
Austin, Texas