Nurses Obtaining PICC Consents

[bobnurse]

We had corporate come in for a mock survey and a "mock" surveyor said that nurses cannot obtain PICC line or any type of consent. Only physicians. We told her she was wrong, and it was basically she's right and everyone else is wrong. So now we have to prove that nurses can indeed obtain PICC Line consents.

In the Bard PICC Course manual it states that nurses can obtain PICC Consents, since they are the one providing the education and will go to court over the PICC Line.

I need more evidence in writing to back this up. Anyone have some info, link, or proof that nurses can obtain PICC Consents. Our nurse practice act does not reference consents and its usually left up to the facilities p & p.

Thanks for your input.

[CritterLover, BSN, RN]

sorry, i agree with the mock surveyor.

it is never a nurse's responsibility to obtain consent.

"obtaining consent" implies informed consent. "informed consent" means that the patient has been educated regarding risks/beneifits of the procedure.

only a physician can give risks/benefits conseling. this is not something that can be delegated. this is not only a state regulation in most states -- including the one i practice in -- but it is also a cms regulation.

where consents are concerned, the nurse's responsibility is to witness the consent, and to check with the patient if there is any other info they need before signing.

it doesn't matter that the picc is being placed by a nurse. it it still ordered by the physician, and it is the physician's responsibility to do the risk/benefit education.

the facility i worked at got "around" this (since we all know that a doc isn't going to come in and give that risk/benefit education, even if they knew what the risks/benefits of a picc were :) ), by having one of the interventional radiologists create a "risk/benefit" education hand-out. hospital legal decided that this was good enough to stand in for the physician-provided risks/benefits counseling. so, once the patient/family reads this, they are able to sign the consent and the nurse can wittness it. (by the way, we [the picc nurses] were not allowed to wittness the consents; it had to be the bedside nurse).

the regulations do not say that only a physician can educate about the procedure, only that the risks/benefits counseling must come from a physician. so it is fine for the nurse to answer additional quesitons. however, there were times that i had to refer some patients that had very specific quesitons they wanted answered prior to picc placement, back to their physician before i placed the picc.

[Kymmi]

I agree with critterlover.....in our facility MD's must provide the education and obtain the consent even though it is being placed by a nurse.

[emmietom]

Question, I have been told that in our state, TX, that a consent is not required for PICC placement. We do have one hospital that does not require a consent. But our company requires the hospitals to get consents prior to our arrival, except for the one hospital who doesn't require consents for picc lines. Any thoughts?

[iluvivt, BSN, RN]

In the hospital I work for in California we no longer have to have the patient sign the consent. This does not mean that the patient does not receive informed consent. The patient or patient's conservator can still refuse the procedure. Yes I felt a little uneasy when we started doing this so what I did was add a detailed description of potential s/sx that could indicate a problem r/t the PICC insertion or the PICC into the teaching documentation. We also ask the patient if they have any questions before we place the PICC.

[emmietom]

that's good to know.. we also have an educational booklet, and our stickers, progressnotes, states we give them the educational booklet and give them a chance to ask questions, and we write iin who gave them the risks and benefits if it's us or the primary nurse. and if I am going to the hosptials that don't require consents, then i ultimatly write a novel!LOL.

[classicdame, MSN, EdD]

As for Texas - any central line insertion is a medically designated act and requires consent. People get confused because it is inserted peripherally. Mid-lines do not require consents because the catheter does not extend to the vena cava. Nurses should not get the consent signed but we all know what general practice is. Docs don't want to take the time and leave us hanging in the breeze sometimes.

[maciv]

Hi all,new to this great forum,in my facility,amajor urban medical center the MD's do not order the Picc lines,they consult the IV/Picc nurses via computer,we in turn evaluate/assess the pt The medical center,nursing service,infectious disease and Legal have allcollaberated with us, the IV/Picc nurses to develop criteria for the placement of Picc lines.I have been placing Picc lines for ten yrs and for the longest time[about six yrs] the MD's obtained the consent and they always had a problem with doing so,as they felt the were consulting us to collaborate and the final decision to place the line was our decision.The consent is a template in the computer and consists of a many part discussion that we have with the patient that covers the RISKS and BENEFITS,OPTIONS,ADVANTAGES AND DISADVANTAGES.The fact that I obtain the consent may have much to do with the fact that I work in a Federal Facility,however our Nursing Administration had many hours of communication with the state BON.It's my practice and responsibility.