Who can translate consents?

Goodyear · Aug 9, 2010

I seem to remember the discussion being along the lines that an unlicensed person may or may not understand the terms and concepts used, and therefore may incorrectly (however slightly) "mis"translate...

What holds up in court, I guess?

ecierra · Aug 9, 2010

Using translators like secretaries and housekeeping staff is a violation of HIPPA, so I know that you can't use them for translating. As I understand it, a certified interpreter can legally translate for informed consent. In our hospital, we have everything in both spanish and english, and we also have a phone in interpreting service available.

Goodyear · Aug 9, 2010

Thanks for your reply!! Let me add some information on my problem.

When prepping to go to the OR, I have to verify signatures, understanding, ask for questions, etc, some things not on the consent proper. We have the phone in service, but being in such a heavily hispanic area, it isn't used and is very expensive, not to mention that in the 5 to 10 minutes we have to get to the OR from holding, I don't think it'd work. I am one of very few who do not speak Spanish, but I do want to be certain those I'm told to use--OR scheduling secretaries, with access and rights to the info, and the CNA's that assist in getting them and the paperwork ready--when I need them are acceptable.

diane227, LPN, RN · Aug 9, 2010

You should consult your actual hospital policy regarding who can act as a translator in your facility. In most places a translator must be a medical person, such as a nurse or physician who is proficient in the language including medical terminology or it must be a certified translator. Also, some facilities have an "approved translator list" of staff who have been approved to translate in that facility. The nursing supervisor on duty at your facility should know how to contact a translator for you. When at all possible, these arrangements should be made in advance. At one facility where I worked we used a telephone translation service that we contracted with and I know many hospitals have used this service and I believe it is provided by AT&T but I am not sure. It is not recommended that you use family members for the translation of any consent.

rn/writer, RN · Aug 9, 2010

Using the Language Line may not be cheap, but it has to be less expensive than a lawsuit or a fine. When I use it at work, it's usually pretty quick, especially for a commonly spoken language like Spanish.

If you're located in a heavily Hispanic area, seems like it would behoove your facility to make certain there are acceptable translators available. I question whether CNAs or secretaries would qualify.

I'm also wondering why the docs are not responsible for getting the consents. They are the ones who are supposed to be explaining the procedure, discussing various surgical options, etc.

If all you are doing is verifying that the signature is authentic, that's one thing and a secretary or a CNA might be sufficient. But if you're discussing anything pertaining to the surgery itself, the doc should be involved. For matters in between, I'd stick with the Language Line or a qualified medical interpreter.

shiccy · Aug 9, 2010

On-Demand Video Service

It's a system called MARTTI (said like the name Marty). It connects w/ an operator, you tell them which language you want, and they connect you to a translator. It's up 24/7 and you can translate ANYTHING. It can sometimes take 5 minutes to get from connection to translating r/t you're calling the translators (sometimes) in their houses. It's video enabled, though some translations are audio only. It also comes at quite an initial price tag, but it is more highly accepted and appreciated for those that you're translating...

The last time I used MARTTI, I had taken care of a lady for two days and we could hardly understand each other. When the translator came on to talk to her, the expression on her face was priceless - it was one of elation that someone actually was speaking her language to her!

The only problem I had was when I was prepping my patient for a colonoscopy... The translator was obviously a bit ... uncomfortable ... with telling her that her BM was not clear enough and needed further prep work

It's billed per minute (some other services are rounded to the 15 minute after mark), and doesn't require you to use any small amount. Prior to having MARTTI we had physical people come in from around the area. It would sometimes take an hour or more to have a translator come in depending on where they were located (some were travelling from 45+minutes away) and if you had a funky dialect, you were sometimes SOL. Also with folks coming in they got 2hrs worth of pay (which was like $50+/hr) automatically ... even if they were there for 10 minutes.

Oh and it works via WiFi, which makes it even cooler!

P_RN, ADN, RN · Aug 9, 2010

We are only witnesses to a signature. It is the DOCTOR'S responsibility to get the consent. Patient relations office should have a translator come in. If you don't understand a language how can you justify witnessing someone signing what THEY don't understand.

Goodyear · Aug 10, 2010

AAALLLLL of these things are things the area supervisor and I discussed, and she thought it ok to use "whoever" works on the unit. Part of the reason she told me this, I think, is because she is the most fluent of the 3 nurses there and I had to use her at a time she would rather I didn't. Even having said that, though, it isa predominantly Spanish speaking area, and about every 5th patient doesn't or won't use English. The questions, etc I have to ask and get answers for are after the consent has been signed---I have to verify the sig, ask for questions, and give answers coherently, etc (prepare just before I take them to the OR). I still use RNs for it, and will continue to. The docs? Honey, if I were to trouble one of the divas, it'd be a very. big. deal. I am learning Spanish but in the meantime will continue to use licensed coworkers. THANKS for all the input!!

HamsterRN, ADN, RN · Aug 10, 2010

In my state, consents must be obtained by using a "certified medical interpreter", when interpreting for reasons other than obtaining consent, the only requirement is that the person be over 18 years old.

I'm a little confused by what you are saying about the Physicians involvement in the consent process, are you saying that the Physicians aren't talking to the patients at all about the risks, benefits, alternatives, etc?

Long Term Care Columnist / Guide · Aug 10, 2010

Using the Language Line may not be cheap, but it has to be less expensive than a lawsuit or a fine. When I use it at work, it's usually pretty quick, especially for a commonly spoken language like Spanish.

If you're located in a heavily Hispanic area, seems like it would behoove your facility to make certain there are acceptable translators available. I question whether CNAs or secretaries would qualify.

I'm also wondering why the docs are not responsible for getting the consents. They are the ones who are supposed to be explaining the procedure, discussing various surgical options, etc.

If all you are doing is verifying that the signature is authentic, that's one thing and a secretary or a CNA might be sufficient. But if you're discussing anything pertaining to the surgery itself, the doc should be involved. For matters in between, I'd stick with the Language Line or a qualified medical interpreter.

I totally agree with rn/writer here. As a fairly fluent Spanish speaker, I've talked women through labor and helped ER physicians determine the LOC of a farm worker who was crushed under a tractor, but I think the Language Line is the most appropriate, and the safest way legally, to obtain consent for surgery and other sensitive topics like end-of-life care. Also, I too am curious as to why doctors aren't the ones doing most of the legwork on surgical consents, as they are the ones who are ultimately responsible here.

Goodyear · Aug 10, 2010

No, the Drs are explaining the procedure, etc., and obtaining the pt's consent. When the pt comes to pre-op holding or day surgery we have to verify understanding of the consent, signatures, and ask if there are any questions about the procedure (in which case we get the surgeon), etc., before we take them back to the OR. For example: Pt has signed consent for a left simple mastectomy. I would say "hello my name is xxx and I am your nurse for this procedure. Can I get your name and birthdate?" (wait for response) "What is it you are having done today?" (wait for response) Most times the pt does not include which side or full information in their response, so I like to clarify and be sure of the EXACT procedure, site, etc, and the pt's understanding of their signature for it and any related consent for blood/products. These are the types of questions that I wonder who can be a translator for. I am learning the language, but in the meantime am using only RNs or Drs to help out.