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What would you do in this situation? (Short)

Posted

I am thinking hypothetically about this since I have been studying and brushing up on med/surg nursing books. I am a new hospital rn.

since it's only a matter of time before I administer blood on the floor to a patient, what do you do if you are trying to get consent for the blood administration but the patient is not alert and oriented (brain damage, dementia, etc.) and the POA is not present (night shift for example)? Or if they don't have a POA to sign?

TheCommuter, BSN, RN

Specializes in Case mgmt., rehab, (CRRN), LTC & psych. Has 15 years experience.

Always remember that consents can be obtained via telephone call. Two nurses (or 1 nurse and 1 physician) must be listening as the responsible party, legally authorized representative or POA provides consent over the phone. Consent paperwork must be signed by both witnesses.

If the POA cannot be reached, a nonemergent transfusion can usually be held until he/she can be reached. Notify the physician that there will be a delay in receipt of the transfusion because you cannot reach the POA for consent. Transfusions can be given without consent if the situation turns emergent.

If the patient is too demented or has too much cognitive impairment to consent to the procedure, and has no POA, legally authorized representative or responsible party to make healthcare decisions, some states allow two physicians to provide consent on behalf of the confused patient.

That makes sense, thank you so much!

I am thinking hypothetically about this since I have been studying and brushing up on med/surg nursing books. I am a new hospital rn.

since it's only a matter of time before I administer blood on the floor to a patient, what do you do if you are trying to get consent for the blood administration but the patient is not alert and oriented (brain damage, dementia, etc.) and the POA is not present (night shift for example)? Or if they don't have a POA to sign?

If the patient doesn not have a POA, then your state law will spell out what to do. The best way to find out how you should handle this is to consult your hospital policies. It will spell out what state law says.

In my state the surrogate decision maker for the patient are the following people in this order: spouse, adult children, parents, adult siblings, adult grandchildren, a friend who has shown a long term interest in the welfare of the patient (e.g. a neighbor who drives the patient to their Dr appointments.) If none of these people can be identified, then the court will appointment someone. Our state law does NOT allow 2 Drs to consent for the patient.

I read recently that Texas law specifies a member of the clergy as the surrogate decision maker of last resort.

Laws vary from state to state so consult your hospital policy.