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.

[Jory, MSN, APRN, CNM]

This would be a question for either the legal department or the ethics committee. Since you would be the one to hang the blood, you need to know what your ground would be if you honored the consent and refused to comply with the surgeon's order.

Because if the patient survives...you, as the nurse, need to know if you have any standing at all if the patient sues.

To me, what the patient wants is what the patient should get...and the consent needs to be CLEAR that no blood products will include, allowing him to die when administering them could save his life.

If the consent did not have this in BOLD type...it should.

[Rose_Queen, BSN, MSN, RN]

If there is a signed blood refusal, it does NOT fall on the surgeon to make the call to give blood or not. The patient already made that call and signed legal documentation. If the surgeon said this before the patient was in the OR, I would not have brought the patient back until the issue was resolved. If the patient was already in the OR, I would have reminded the surgeon of the blood refusal. If he still insisted on having blood, I would have gone up the chain of command. You are the patient's advocate when they are unable to advocate for themselves.

[MereSanity]

You are the only one protecting your patient during their most vulnerable time. You are at times your patients only advocate. I also would not have brought the patient back until the issue was resolved. The doctor is not always right. I would have pulled in the OR manager.

[QTNurseBSN]

Jehovah Witnesses believe that the Bible prohibits ingesting blood and that Christians should therefore not accept blood transfusions or donate or store their own blood for transfusion. I thought that most MDs, to include surgeons, have had Jehovah's Witnesses as patients and understand that they can NOT accept blood products as part of their religion to include red blood cells, white blood cells, platelets or plasma. It is a non-negotiable religious stand and those who respect life as a gift from God do NOT try to sustain life by taking in blood. Giving blood to a patient, after they have provided a signed refusal for blood could very well be grounds for a lawsuit! Regardless of what the surgeon would've wanted, if the need for blood did arise, you as the nurse would have been held accountable for administering it. I personally would've refused to hang the blood if that did happen, especially knowing that the patient has refused and provided a signed refusal.

I know several Jehovah Witnesses and they are NOT allowed to accept blood, doing so would cause intervention by the Elders of their congregation and thus cause them to no longer fellowship with other members of their congregation, thus resulting in being shunned. Now if this was done in an emergency situation (for example, car accident and patient is bleeding out and unconscious) that would be totally different as the patient did not give consent or refuse administration. Most JW will carry this documentation in their wallet for this reason and will even give copies to members of their family.

For future reference, if this ever happened again, I would definitely consult with my manager or attempt to resolve the issue while patient is still in Preop. The surgeon needs to understand the religious and legal issue plus respect the patients wish, explaining that death could possibly be the end result, which they already know and accept.

[ruralgirl08]

This would be a really good in-service topic for your department, to clear up any misunderstandings.

[sugarik13]

Thanks everyone. I did confirm with my nurse educator and she told me blood should NOT have been ordered. Just want to clear up any confusion...there was not any confusion about the consent or an issue in pre-surg. All the right consents were signed by the time the patient came to the room. And the surgeon was not arguing. When he asked to have 2 units of blood sent up I questioned the other circulator in the room (my preceptor for the day) and was told that I should still get them sent regardless of the signed refusal. My educator told me next time to remind the surgeon about the signed refusal and if HE or anyone else insists on ordering blood or trying to get me to do it, to bump it up.

[TakeTwoAspirin, MSN, RN, APRN]

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

[wooh, BSN, RN]

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

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...

[Rose_Queen, BSN, MSN, 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...

Especially if they're already anesthetized. Most people who are awake (in my experience) ask about the red band and what it's for.

[wooh, BSN, RN]

Especially if they're already anesthetized. Most people who are awake (in my experience) ask about the red band and what it's for.

And not all facilities use a red band.

[TakeTwoAspirin, MSN, RN, APRN]

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...

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.