Jehovah's Witness and Blood Refusal in OR

[sugarik13]

Hey! Last week I circulated with another nurse (I am still on orientation). We had a patient who was a Jehovah's Witness, so along with a signed surgical consent there was a signed refusal for blood. I was told to have 2 units of PRBCs on hand in the fridge by the surgeon. I pointed out to my co-circulator that the patient was a Jehovah's Witness and had a signed blood refusal and showed it to him. I asked him if we should show it to the surgeon as a reminder. He said not to show it and told me to have them brought up anyway because when the patient is on the table it falls to the surgeon to make the call between saving a life and letting the patient bleed out. I thought that this was wrong but did what I was told and had the blood sent up. Thankfully we didn't need it, but I want to know for next time how to handle the situation.

[morte, LPN, LVN]

maybe they were simply flat out lied to.

[Esme12, ASN, BSN, RN]

It's not like the average patient knows this tube is going to be a CBC, that tube is a CMP, and THAT tube is a type and cross...

Most facilities now a days have the huge BB bands and BB tubes that have to have matching labels It is hard to disguise what you are doing.......I don't think the blood should be any where near the patient in case someone makes a mistake in an emergency.

I would be incredibly uncomfortable.

[vld123]

A very enlightening discussion thanks for posting.

[NurseDirtyBird]

But these patients are not "average" when it comes to blood products. Because of their beliefs they have a heightened awareness to these things (obviously) and I find it hard to believe that when labs were done prior to the surgery that they did not even mention their aversion to receiving blood products.

Someone did mention that it is possible that the patient was unconscious, I'm assuming implying that this was a trauma-induced surgery of some kind. There is nothing in the OP's original post that indicates this was anything but a routine surgery where pre-op testing was done some period before the surgery. Also, the patient was aware enough to sign an informed consent so presumably was also aware enough to understand blood was being drawn prior to surgery - you don't have to be a health care professional to understand that pre-surgery blood draws aren't looking to see if you have a vitamin deficiency.

I think those who say that the public doesn't understand what is going on are underestimating the public. Patients are a whole lot more informed and educated about what is going on these days, and I struggle to believe that a JW patient isn't even more on the ball with such things considering how important it is to them.

So it would have been the JW pt.'s fault if they got blood products just because they allowed a type/cross pre-op, even if they signed a no-blood products consent?

Who cares if they had that particular test done, and who cares why? The form was signed, they refused any blood even if the surgeon just happened to know their blood type.

[TakeTwoAspirin, MSN, RN, APRN]

I have no idea how you interpret what I said as being in any way that I was trying to blame the patient for anything. Quite the contrary. I'm trying to understand how the system in this facility failed to intercept this at an earlier time and prevent this from going as far as it did - blood being ordered for the room. I care because this is a failure in the process of this facility, and unless somebody cares then it is likely to happen again. Sorry for caring - you should try it some time. BTW, nobody gets blood delivered to an OR room just "because the surgeon happened to know their blood type". That simply does not happen.

[ktwlpn, LPN]

I took that away from your response,too .There are many reasons for a blood draw prior to surgery.In my experience a certain generation of patients just do not question medical staff and I can see how they would not question the blood draws.They know they signed the form stating they were refusing blood and blood products and probably felt comfortable that the staff would honor their wishes.I have cared for JW's in acute care and they didn't sit there and repeat over and over "I'm a Jehovah's Wintess!" to everyone that entered their room.

[morte, LPN, LVN]

maybe they didn't type and cross, maybe they ordered up a couple of units of O-.

I'm sorry, but why would a JW patient consent to be type/crossed/screened if they knew they were going to refuse transfusion?

We don't "consent" people for lab draws and, unless the patient specifically asks, I don't generally explain each test that's to be run.

[KelRN215, BSN, RN]

If there is a signed refusal for blood products, it is NOT the surgeon's call. Competent adults have the right to refuse treatment, even on religious grounds that we may not agree with.

Even in the case of children... the courts in my state have long held that parents are free to be religious martyrs/refuse treatment for themselves based on religious reasons but that they are not free to make those decisions for their children. We still need a court order to hang blood on the child of a Jehovah's Witness who won't consent to a transfusion.

[NurseDirtyBird]

I have no idea how you interpret what I said as being in any way that I was trying to blame the patient for anything. Quite the contrary. I'm trying to understand how the system in this facility failed to intercept this at an earlier time and prevent this from going as far as it did - blood being ordered for the room. I care because this is a failure in the process of this facility, and unless somebody cares then it is likely to happen again. Sorry for caring - you should try it some time. BTW, nobody gets blood delivered to an OR room just "because the surgeon happened to know their blood type". That simply does not happen.

Firstly, "...I struggle to believe that a JW patient isn't even more on the ball with such things considering how important it is to them," pretty much reads as, "They should have known better."

Secondly, my statement regarding the surgeon knowing their blood type meant that a type/cross lab does not indicate that the patient should receive blood, and that's pretty clear.

Thirdly, accusing me of not caring because I disagree with what you said is pretty low. In case you think I took that out of context, I went ahead and highlighted it in your quote. Come up with an actual argument instead of insults please.

[IftheShoeFits]

as an almost new nurse entering the field, this discussion has been very helpful.

It is the hardest thing as a healthcare worker, hardwired to save lives with resources available, to not use those resources.

[ShauntaNicole]

As a Jw ,i just wanted to comment its not that we dont want ANY help,its that there are many other procedures a dr can perform, even in life threatening situations. Procedures that can sustain,or maximize the blood one already has,etc. And actually what each jw does vary according to ones conscience,and some jws feel comfortable taking blood portions ,but not whole blood.......