Ok, I know this topic has been discussed but I was not able to find my question specifically. Let me give some background... For as long as I have been doing PICC's at my facility we have been using the generic consent form. Its a consent form that is used for all types of procedures and the procedure is written in. We also have these beautiful PICC consent forms with risks and benefits on there. The lead we once had is no longer in employment with us and a few months back I had requested that nursing use these forms to obtain consent. Our process has always been the bedside nurse to have the consent form signed. We do this because the PICC team do other procedures during the day and the PICC's go in after our line up is done. It is easier for the bedside nurse because often we get confused patients or patients in the ICU sedated who cannot sign for themselves and they have a greater opportunity to connect with family. Our current policy states the physician will obtain informed consent. So just the other day the manager of Med/Surg states me using this form is a change in practice. She was telling me that in the past it was decided that the PICC nurses would do the "Informed Consent" process because we are the experts (which I do agree) and have the patient sign that consent form. Again, I see many barriers with patient confusion and sedation issues as we do not do this all day long, its a small portion of our day.
This is the problem... The bedside nurses feel uncomfortable signing this form with the patient as they are intimidated by the lingo.
My question is... What are the benefits to using this PICC consent that beautifully lists this information out? Any legal benefit to using it? Should I just switch back to the generic consent?
My first problem with your situation is ..."we don't do this all day"..."A Vascular Access nurse should be handling the Vascular Access and not doing "other" things.. In order to be expert at this (insertions all all types) you need to do this and only this. Do you know any cardiac surgeons that also do bowel resections? But as nurses we find it hard to say " we only do this...". Vascular Access is a ever evolving field. I have been doing "just this " for 11 years and I have to say my practice now looks alot different than what I did 11 years ago.
Now consents: Think about this. Your the expert..your inserting the line...you know every risk and benefit better than anyone else in your hospital......why would you NOT consent the patient? As good as you are....I wouldn't want anyone to get my consents. It's my responsibility morally and legally.
Jack Diemer
Informed consent is a process and NOT a signature on a piece of paper. This process requires patient education, addressing their concerns and questions, explaining risks, benefits, and alternatives. That last one is a very important one! The person performing the procedure is the one and only one to do this education. This is true for any surgical procedure or any other invasive procedure. So that means the infusion/VA nurse is the one do to this education. The staff nurse is ONLY a witness to the signature of the patient. It does not matter which form you use because a signature on any piece of paper is not the complete process. You and your team nurses are the ones to do this education and get that signature. The only exception to this is in states like CA where there are laws stating that a physician must be the one to get informed consent for everything. Lynn
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
One more thought. The risk manager at your facility must be involved with creation of the policy and procedure for any informed consent because this is a risk management strategy. So get to know that person and follow their lead on this issue. Lynn
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
Sorry, typing really quick. We are in CA and our policy states that the licensed prescriber gets informed consent. As a vascular access specialist we educate the patient. I am focusing on the consent form.
Also so we are a small hospital. If I were to do PICC linrs and only PICC lines I would starve. I know a lot of facilities around here who do both Picc other things. Not meaning to be rude. Typing from phone. I want to focus on the consent form.
Again, my opinion is that the specific form does not matter. The bottom line is what the patient understands about the entire process. Can you honestly say that each and every LIP who prescribed a PICC is doing all of the patient education needed for a PICC insertion? So that responsibility goes directly to the person inserting it because you have or should have significantly more knowledge than the staff nurse. I do agree that this is a specialty practice and your time and focus should not be diluted with other patient care. That is an administrative decision that is probably out of your hands at the moment. But it is also my strong recommendation that you work toward becoming a speciatly team that practices the entire scope of infusion/VA services. When you do that this question of who is getting the consent formed signed goes away. One other thought - over the past 19 or 20 years, I have been the expert on hundreds of malpractice lawsuits involving infusion/VA issues. I have never seen this consent form be an issue in any of those cases. Education is an issue though in many cases. What did or didn't the patient understand about the procedure and very importantly is were they educated about alternatives. I have seen some situations that do this very well, but others that fail miserably. Lynn
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
I have a meeting with the managers and with Risk Management on Monday and I want to be prepared. That is my reason for this discussion. Our process apparently needs to be revisited. Lynn I am curious to know how you see good education documented? For us, it is currently documented on our PICC insertion form.
It could be delivered in a written brochure, or a video on your internal closed circuit TV, or by verbal instructions. Documentation would emphasize that the patient understands whay they have been taught. This is done by discussion, the nurse asking questions about the patient's concerns, issues, expectations, etc. For teaching a task like a patient giving their own meds in preparation for going home, there is demonstration and return demonstration. The education process is about identifying the gaps in knowledge and then choosing teaching methods that are intended to close that gap. You could use a checklist format including the method of delivery, and how patient/caregiver/family knowledge was validated, a narrative note about the questions they asked. The information given to the patient must include what, when, where, how, and why of the procedure; the risks and benefits; and alternative methods of delivering the infusion therapy. I have often seen a surgeon write orders for the surgical procedure for an implanted port and for the nurse to tell them what that was but no one is telling the patient about the other choices for vascular access. The same thing could be true for a PICC. There are lots of articles about patient education. One of the primary competencies that everyone is now focusing on is based on the patient's age. So your communication with them has to be appropriate for the patient's age and educational level. For someone with only a 5 or 6th grade education, you would teach them differently than someone with a master's or doctorate degree. Good luck with your meeting on Monday. Lynn
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
We do this all the time in oncology. The oncologist explains the diagnosis, lists the risk and benefits of therapy and prescribes the treatment. They are responsible for obtaining informed consent (the signature on the consent form). The next thing they do (and this is my favorite part and why I love being a nurse) is that they set up new chemo teaching with the oncology nurses! So even though the physician is obtaining the informed consent (which, by the way, according to ASCO and ONS standards, could be a simple line in a patient encounter indicating the patient grants consent), it is the nurse providing the new chemo/patient education. I do virtually all of the new patient education and I include an extensive note about how we discussed the prescribed therapy, goals of therapy, infection prevention, self-care, etc. I see this as all part of the consent process and it ensures that the patient is informed. There have been occasions (not many) during my teaching encounters, when points have comes up that require further discussion with the physician and the prescribed therapy changes. This could just as easily happen when doing education prior to a new PICC.
I work in CA and even though it is the resident who gets the consent form signed, it's the PICC nurse doing the education. As far as I'm concerned, the education is AS important as the actual insertion! I think we get really hung up on the signature on a consent form when "informed consent" means so much more than that.
Keith W. Gilchrist, MSN, RN, PHN, OCN, CRNI, VA-BC
Oncology Nurse Navigator, David Grant Medical Center
Travis AFB, CA
One more suggestion. Include a family member or significant other when providing the education to the patient who will provide consent.
Ann Zonderman, BSN, JD, CRNI
Great point Ann ! Definitely needed. Lynn
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