I need your opinions please....

[chicookie, BSN, RN]

As many of you know, I work for a Bloodless program. We are trying to make a form that is very VERY nurse/doctor friendly.

We all know that Witnesses don't take blood but when it comes to the minor fractions and certain medical procedures each individual has to decide. We already have a consent form in place but we get alot of complaints about it, usually the complaint is that it's not detailed enough. This is a rough outline of what it would look like(It looks like a table and next to the accept and reject would be check boxes or have the patient initial, whatever legal decides.). We would also have several of them tailored to different areas (L&D for example would list the Rhogam shot). Pretty much what I would like to know is if you saw this form in a patient's chart would it be something you would understand or would it bring up more questions. Any suggestions would be much appreciated.

Thank you so much!

NO TRANSFUSIONS of whole blood, red cells, white cells, platelets or plasma (including fresh frozen plasma)

MEDICAL PRODUCTS

Albumin

- Procrit (EPO)

¨ Accept

¨ Reject

Immunoglobulin

¨ Accept

¨ Reject

Clotting Factors

- Cryoprecipitate

- Fibrin Glues or Sealants

- Evicel

¨ Accept

¨ Reject

Other:

MEDICAL PROCEDURES

Cell Salvage (Auto-Transfusion)

- Intraoperative

- Postoperative

¨ Accept

¨ Reject

Hemodilution

¨ Accept

¨ Reject

Heart-Lung Machine

¨ Accept

¨ Reject

Dialysis

¨ Accept

¨ Reject

Other:

PS I tried asking nurses on different floors here and the only suggestion/comment I received was that it was a nice font.

[homecarelpn]

Its to the point. I see no problems with it.

[Whispera, MSN, RN]

You need a brief explanation of what the form is for, and how it's to be used, at the top. Also, for the parts that have more than one product or procedure listed, like "clotting factors," either keep the items under the heading off the form, or let the person choose accept or reject for each of them. Do you need to list the individual products or not? In other words, would "clotting factors" cover all clotting factors?

[workingspaz]

looks really good; but will it all be left justified? i'd make some more columns (maybe three across?)

oh, and i'd have at least one line space like this

_ Accept

_ Reject

so as no confusion about what exactly they are checking. it does look pretty good :)

[chicookie, BSN, RN]

homecarelpn: thanks!

Whispera: I think it would be a good idea to list them because I don't think many realize for example that Procit has albumin in it. On the form I have those indented, kind of like a subheading. Plus some of the docs have asked certain products be listed. My thinking was if you accept clotting factors then you accept in no matter what form but I think your idea of putting accept/refuse on all them is great because you never know how picky the patients is. Thanks~

@workingspaz: no its on a table but when I copied it, it showed the table but it disappeared when I posted. It looks more like this:

Albumin *space* (check box) Accept *space* (check box)Refuse

Each section is its own box. Formatting is a bit weird when I post it on here. Thanks!