[professorwannabe]

Hi all,
I tend to just lurk and learn but I would like to hear from you regarding getting signed informed consents. Until just recently, the nurses on my team were required to have a signed consent, after we explained the PICC line, procedure, risks and benefits. We had the attending RN sign as witness as we were told that if we witness the consent, it could be considered coersion. Recently, due to some Joint Commission recommendations, our corporate offices developed a new consent with wording that excluded nurses. We had a separate consent we used and therefore thought we would continue to do so. However it has been confirmed that the PICC team would no longer be getting signed consent. We would continue to explain the procedure, including the risk and benefits and if the patient said okay, would proceed with the insertion. In our documentation we do mention the explaination we provide.

The hospital is saying that the general consent to treatment the patient signs when they are admitted covers us for this "invasive" procedure, much like it covers all nurses when we insert peripheral IVs, place foleys, and sink NG tubes, the type of procedures we all learn, whether we are in diploma, ADN, or BSN programs. Doctors who insert PICC lines continue to get consents as they are independent practitioners unlike nurses who work for the hospital. I guess when we have a patient who is unable to give consent, we would just place the PICC also without calling the family as we don't call them to place a foley in that type of a patient.

I know this is long but tell me what do you think of this. I am thinking I need another position.

[RN1989]

The hospitals I have been in most recently have stopped having nurses put in PICCs. All PICCs are now put in by the radiologist using flouro. I am unsure why they did this - never could get a straight answer out of anyone. But I've overheard docs talking that they don't feel nurses should be putting in PICCs on the floor. I found this odd because I came from a big place that had a PICC team. But no matter who put it in, the floor nurse was always responsible for getting the consent from either pt or family, just like putting in a TLC.

[nosad7]

Our PICC team has researched this issue ad nauseum. Here is how it breaks down in PA. The PA State Board of Nursing stated to me "we don't address informed consent[go to State Medical Board ?]"and there is no such thing as "nursing consent". Our legal eagles have gone back and forth about this issue, finally deciding that the general hospital consent to treatment covers PICC insertion. We will be using a form that includes a " PATIENT EDUCATION provided " line where the patient can sign off on being presented with information concerning PICC line placement. This will not be presented as "consent".

[bobnurse]

I asked this question a while back and got this response.

It is never a nurse's responsibility to obtain consent.

"Obtaining consent" implies informed consent. "Informed consent" means that the patient has been educated regarding risks/beneifits of the procedure.

Only a physician can give risks/benefits conseling. This is not something that can be delegated. This is not only a state regulation in most states -- including the one I practice in -- but it is also a CMS regulation.

Where consents are concerned, the nurse's responsibility is to witness the consent, and to check with the patient if there is any other info they need before signing.

It doesn't matter that the PICC is being placed by a nurse. It it still ordered by the physician, and it is the physician's responsibility to do the risk/benefit education.

The facility I worked at got "around" this (since we all know that a doc isn't going to come in and give that risk/benefit education, even if they knew what the risks/benefits of a picc were ), by having one of the interventional radiologists create a "risk/benefit" education hand-out. Hospital Legal decided that this was good enough to stand in for the physician-provided risks/benefits counseling. So, once the patient/family reads this, they are able to sign the consent and the nurse can wittness it. (By the way, we [the picc nurses] were not allowed to wittness the consents; it had to be the bedside nurse).

The regulations do not say that only a physician can educate about the procedure, only that the risks/benefits counseling must come from a physician. So it is fine for the nurse to answer additional quesitons. However, there were times that I had to refer some patients that had very specific quesitons they wanted answered prior to picc placement, back to their physician before I placed the picc.