Consent to drug test OB/L&D Patients

Nurses General Nursing

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Currently, the hospital I work at performs urine drug tests to patients who meet certain requirements like no prenatal care, questionable appearance or behavior, low birth weight, still birth or miscarriage, any hx of use...you get the point. The patients are not informed they have even been tested unless the test comes back positive-then the social worker is called and she's who tells them.

A new policy is in the process of being passed about having the patients sign a consent for this testing. If the patient refuses, they plan to test the baby without permission after birth with the refusal as "reasonable cause". I don't see the point in the policy (I support the random tests), but I was wondering if anyone else works where they have this rule?

Why not test everyone?

We don't need consent for our urine drug screens. They aren't "legal" in that they wouldn't stand up in court for prosecution. We don't have a true chain of command, we don't measure the temp, we don't watch the collection. If someone asks, I just tell them it's not for prosecution purposes, it's to make sure there is nothing that would interfere with their care--no withdrawals that could have been avoided, no drug interactions, that sort of thing. I let them know straight up we don't follow the procedure for having these stand up in a court of law, so they *can't* be prosecuted for drug usage based on this test. I try to convey that I am not interested in judging them, I just have to know what's going on to help them.

Mostly they don't ask, though. I just tell them I need a urine specimen. Usually we are also running a UACI, too.

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Gads!

Justify this all you want but aren't you missing the simple fact here? Informed consent! Maybe grab a genetic test for DNA problems while you are at it, of course you will want to bill the patient for that also. The line that you are not going to use them to get them arrested doesn't hold water either. Pt records can be supenoed and could show a trend or better yet explain why this lab isn't valid when all your other ones on this Pt are? Simple fact of the matter is you are doing a search without consent.

The question of consent is important in medical law. For example, a surgeon may be liable in trespass (battery) if they do not obtain consent for a procedure. There are exemptions, such as when the patient is unable to give consent. Nuff said

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Got your tinfoil hat?

A consent form is signed upon admission. Do I need to get an individual consent form signed for every test, every lab stick, every IV stick, every dose of every medication? The results aren't used to prosecute; they are used to treat. If my dude took some coke and then he gets all tachy and has chest pain, I have to know that, it affects what sort of treatments I can give him; otherwise I might contribute to the problem.

I should mention I am speaking of general medical pts; but we have the same philosophy throughout the hospital, including L&D.

When I say it's not valid for prosecution, I mean just that. There are certain procedures that need to be followed for legal drug screens, including visualizing the collection, noting the temp, sealing the container, and not letting it out of your sight until it is handed off to the lab tech. If the pt was somehow accused and prosecuted on a medical drug screen, it can't hold up because these things weren't done. Anyone who has been in the system knows this. It is considered valid for treatment, but it wouldn't hold up in a court of law.

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As one poster already said, if you're not doing drugs, you really won't mind being tested.......Too many rights as it is for those who break the law.

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Just like I have the right to refuse any other test, I have the right to refuse a "non-legal" drug test. If you feel its necessary thats great but I won't pay for it especially when I have no "risk factors" nor is there any reason other than standard protocol to do it.

And people wonder why homebirths and birthcenters are becoming more popular.

if my local L&D did routine drug tests for any L&D patient I wouldn't be going there despite never using. I shouldn't have to pay for osmething my insurance may not cover because of every other perosn out there.

I also think its completely unethical to test a patient for something without their consent, with the exception of legal reasons. If there is concerns with baby showing active signs of drug use... then fine it should be allowed but certainly not everyone who refuses.

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Specializes in LTC, Med/Surg, Peds, ICU, Tele.
We test all babies. A trip to the NICU means you automatically meet the criteria.

IMO - "reasonable cause" is "you are my patient and I need to know what's going on to treat you effectively and safely." I'm not here to arrest you, or lecture you about your stupid choices....just keep you healthy.

How do you feel about applying the same standard to HIV?

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Specializes in Community, OB, Nursery.

We test babies of moms who a) admit to drug use; b) admit to a history of drug use; or c) got no prenatal care. We also keep in close contact with the county's social services, and they also give us a heads-up of people who are being followed and mom is expecting.

I personally think we should be testing everybody if we're going to be testing people who meet the above criteria. Not because I want to be Big Brother-ish but because drug use/abuse is not limited to people with a known hx. It's not in that baby's best interest to be withdrawing from drugs without treatment. Now, I work with withdrawing babies enough to know what withdrawal looks like.....but by the time he's showing sx, it might be too late to know what exactly he's withdrawing from.

I tell people what I'm getting a urine sample for. Oh sure, we get people who swear up and down that they're clean and that we must have switched their urine or something. But that's few and far between. And I tell them what I'm getting a sample from their baby for. Most people have no problem with that, and if they do, I have a chat with them and let them know, as another poster said, this is not about my judging your choices. This is in your baby's best interest; babies have died from untreated withdrawal from some drugs.

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Specializes in Community, OB, Nursery.
How do you feel about applying the same standard to HIV?

We have a state law that requires us to HIV-test all women in pregnancy at least once. If they do not consent during the pregnancy, then we have to test the baby at birth. Like I said, this is state law. I have never ever had a mom refuse that. I tell people that we're testing them for HIV, and it's not because we're picking on them, but that we test everybody. We have had several new HIV diagnoses from this mandate.

I understand that there's a stigma attached to HIV still, but we don't require consent for any other STD testing - and we do HBSag, RPR, GC, and chlamydia during pregnancy. I have mixed feelings about doing things to people that they don't consent to, but I have never had people refuse this test when I explain to them what's going on.

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Specializes in NICU.
How do you feel about applying the same standard to HIV?

All mothers in my state are tested for HIV at their first big bloodwork appointment.

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Specializes in LTC, Med/Surg, Peds, ICU, Tele.
All mothers in my state are tested for HIV at their first big bloodwork appointment.

I was talking about testing all patients. Why limit it to mothers?

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Specializes in home health.
i'm sure my take on this is most likely controversial. i happen to work in a women's hospital and my view is test everyone that walks in the door. if you have nothing to hide, you won't mind it. (emphasis added)

i have a huge problem with this attutude!

there is a constitutional right (given by our creator, not by the govt) called the 4th amendment (unreasonable seach and seizure) this includes parts of your body. (or in the case of a minor, your child's body) get a warrant, based on probable cause evidence if you aren't going to obtain consent

just because someone wants to maintain privacy (in this open book society of our where it seems everyone else has a right to your business) does not mean they are hiding something.

tencat said

"as one poster already said, if you're not doing drugs, you really won't mind being tested.......too many rights as it is for those who break the law. "

i don't do drugs, never have, never will. i do mind being tested without consent

it's just plain wrong. it's the exact same thing as searching my home with out a warrant

big brother is alive and well.

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I wouldn't consent to a drug test because I don't do drugs so I would know my baby is fine and wouldn't want to incur additional costs. I'm sure other woman who are clean would feel the same way and not even realize that their denial or acceptance will result in the test being done anyway.

I wouldn't pay if they tested my baby and I didn't consent to it. If they didn't have reason other than my denial to test my baby I would be livid. I could see if I didn't consent and my baby showed signs of drug dependency but running it based on my saying no?! No go. Many will say no in complete and utter innocent. I wouldn't pay the bill and I might make a complaint too. I think this is a money making machine.

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