Consents for inpatient acute hd

nutella, MSN, RN · Jun 4, 2016

Does anyone know of any hospital systems than require a specific consent for hd? My company started this last fall and it has been a pain. Just curious. Thanks

Yes, I worked acutes in three different hospitals and in all of them patient had to consent. In one hospital the consent was valid for one year so all patients had to sign once a year in acutes. Another hospital did consents on all true acutes but anybody who was a chronic and got HD in the hospital because they were admitted for whatever did not need a consent for a while - then they changed to every 2 years or something like that.

If the hospital has a electronic health record it can get scanned in so you can check it prior to the tx. If it is paper you can check if you are allowed to make a copy of the consent and keep it in a a-z drawer file thing. That way you can check when a patient gets re-admitted.

Of course every true acutes or new start should have a consent because the risks are specific and the MD needs to explain that...

CFrancine, BSN, RN · Jun 30, 2016

For chronic ESRD patients, we do a "consent verification". It asks them where they receive their treatments, they still understand the risks and benefits as explained by a LIP, and they are OK with the hospital doing the treatments while they are admitted. Can be done by any IHD staff member. BUT they make us do the EVERY TIME the patient is admitted. So we have tons of frequent fliers and we have to keep doing this, checking the admission date, checking when the last one was signed, etc etc.

AKI patients get informed consent when they first start. Usually the doctor writes "hemodialysis - all modalities" to cover CRRT and IHD. This is valid for the full admission. Some AKI patients keep coming back to us after discharge because they haven't been declared ESRD just yet. So thier first treatment as an outpatient, they have to do a full informed consent again. This is valid until they are declared ESRD and go to their newly assigned chronic unit. If they are admitted to the hospital ever again as an AKI, they have to do an informed consent again. If they come back after being ESRD, then it's as above.

lawandaluxnurse, ADN, BSN · Jul 1, 2016

We have to get consent with each new hospitalization including chronic patients. I wish they would do like blood consents. It gets to be a real hassle at times

Chisca, RN · Jul 1, 2016

Which begs the question, has there every been a successful lawsuit against a nurse for a hemodialysis treatment given without consent? In the state of TN the answer is no.

westieluv · Jul 1, 2016

Which begs the question, has there every been a successful lawsuit against a nurse for a hemodialysis treatment given without consent? In the state of TN the answer is no.

Good question. When I worked acutes a few years ago we had a situation where the patient was a male found comatose in a public park with an empty bottle of antifreeze lying next to him and no ID on his person. They had no way of identifying him or finding a next of kin to sign a consent in a timely manner since he needed a STAT HD tx after it was discovered that he had drunk a bunch of the antifreeze in a suicide attempt. One of our nurses ran him for seven hours overnight and I came in the next day and ran him for an additional three and a half hours. He survived and was able to go to the psych ICU and then home in stable condition a few days later, but I wondered for a time after that if he would have had any grounds to sue us, since neither he, nor anyone else, had consented to the treatments and his objective was presumably to be allowed to die. I've never heard another thing about it, so I guess he didn't pursue anything or he looked into it but was told he didn't have a leg to stand on.

NurseRies, BSN, RN · Jul 3, 2016

I don't know that it's any different then a Jane doe who needs blood to live. They don't question giving her blood do they? I don't know for sure, but I would guess that they assume everyone is a full code and wants everything done unless they can find other means to prove it. I am sure this is covered by liability . If I do a patient emergently with no family, the doctors signs the consent and writes something like "medical emergency, no family available, patient unable to sign".

AcuteHD · Jul 14, 2016

We have to get consent with each new hospitalization including chronic patients. I wish they would do like blood consents. It gets to be a real hassle at times

Our hospital requires a consent for every admission, even for chronic pts and the ones that use the hospital for their routine treatments (uninsured). How does your hospital do blood consents?