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Hi All,
I would like some advice from the group on gaining informed consent from
the source of a blood and body fluid exposure and timeliness of bloods
being sent for testing, in particular if the patient is aneasthetised.Our current situation:
On our generic consent form for procedures it has a ‘sentence’ regarding
bloods being taken from them whilst anaesthetised for the purpose of
testing re if there is a needlestick injury during their procedure. I
have never been comfortable with this as there is no risk assessment,
discussion regarding what tests or how we keep that information
confidential. Although there has been a signed consent, I do not see it
as an informed consent. Also if Drs use their own consent forms this
‘sentence’ is not included.If we wait 24 hours post anaesthetic then potentially you could miss the
window for administration of post exposure prophylaxis .If the patient is not anaesthetised then the management is completed
using a signed consent and discussion regarding results of tests with
treating Dr or infection control.Thank you for your assistance in advance
Kind Regards
Nicola Swindells
Infection Control /Quality and Risk Manager
Mater Hospitals Central Queensland
Rockhampton Yeppoon Gladstonenswindells@mercycq.com
07 49313420This email does not necessarily constitute an official representation of Mercy Health and Aged Care Central Queensland Limited. Any unauthorised use of the email or contents is strictly prohibited. Emails may be interfered with, may contain computer viruses or other defects and may not be successfully replicated on other systems. It is your responsibility to scan this message and any attachments for computer viruses or other defects and Mercy Health and Aged Care Central Queensland Limited gives no warranties in relation to these matters.
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Hi Nicola
Yes, always difficult, this question. I agree than a generic statement on a generic consent where no discussion of tests occurs is not valid, and so did all of the lawyers I have heard that have been asked this over the years.
That then raises the issue of when you can get consent, and what type of consent it required (implicit, verbal, written?). If you wait 24 hours after the procedure you potentially increase risks to the HCW exposed, so that is a poor option. If you gain consent when the patient is not considered legally competent it would again potentially be an issue if the patient ever complained about the testing. Not sure what the perfect answer is, but my common practice has been to ask the surgeon or treating doctor if we can ask the patient for verbal consent for the testing after they have woken from the anaesthetic, or if we need to involve next-of-kin in any discussions. Most surgeons will readily agree to asking the patient, but at least we have asked for medical advice on their ability to consent to the testing. For patients who are intubated and sedated for a period post op (eg cardiac surgery), we ask this question of the intensivists treating the patient. Not perfect, not a signed record, but a common practice when we often get only verbal consent for various things, including major tests for cancer (potentially more life changing), within 24 hours after an anaesthetic. Using a simple printed sheet that explains the basics of the tests also may help.
I can’t provide any legal advice on this obviously, but suggest you discuss with your facility medical director as to the best approach that will be considered good practice. If you and the medical director are agreed on how the process should work, then at least the facility could respond to any legal enquiries relating to complaints from patients with a united front. You might also want to seek further legal advice from facility legal staff. As always, a written protocol for all to follow, and even printed information to give patients they can keep, can be useful with this.
Look forward to more discussions and opinion on this.
Cheers
MichaelMichael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
Please consider the environment before printing this emailHi All,
I would like some advice from the group on gaining informed consent from the source of a blood and body fluid exposure and timeliness of bloods being sent for testing, in particular if the patient is aneasthetised.
Our current situation:
On our generic consent form for procedures it has a ‘sentence’ regarding bloods being taken from them whilst anaesthetised for the purpose of testing re if there is a needlestick injury during their procedure. I have never been comfortable with this as there is no risk assessment, discussion regarding what tests or how we keep that information confidential. Although there has been a signed consent, I do not see it as an informed consent. Also if Drs use their own consent forms this ‘sentence’ is not included.
If we wait 24 hours post anaesthetic then potentially you could miss the window for administration of post exposure prophylaxis .
If the patient is not anaesthetised then the management is completed using a signed consent and discussion regarding results of tests with treating Dr or infection control.
Thank you for your assistance in advance
Kind Regards
Nicola Swindells
Infection Control /Quality and Risk Manager
Mater Hospitals Central Queensland
Rockhampton Yeppoon Gladstone
nswindells@mercycq.com
07 49313420This email does not necessarily constitute an official representation of Mercy Health and Aged Care Central Queensland Limited. Any unauthorised use of the email or contents is strictly prohibited. Emails may be interfered with, may contain computer viruses or other defects and may not be successfully replicated on other systems. It is your responsibility to scan this message and any attachments for computer viruses or other defects and Mercy Health and Aged Care Central Queensland Limited gives no warranties in relation to these matters.
Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.
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WARNING : This email contains information, which is CONFIDENTIAL, and that maybe subject to LEGAL PRIVILEGE. This e-mail and any attachments to it (the “Communication”) is confidential and is for the use only of the intended recipient, and may not duplicated or used by any other party without the express consent of the sender. The Communication may contain copyright material of St Vincent’s Health & Aged Care(“SVHAC”), or any of its related entities or of third parties. If you are not the intended recipient of the Communication, please notify the sender immediately by return e-mail, delete the Communication, and do not read, copy, print, retransmit, store or act in reliance on the Communication. Any views expressed in the Communication are those of the individual sender only, unless expressly stated to be those of SVHAC. SVHAC does not guarantee the integrity of the Communication, or that it is free from errors, viruses or interference. Thank-you.Message protected by MailGuard: e-mail anti-virus, anti-spam and content filtering.
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Nicola, my understanding is that under the 2008 Health and Wellbeing Act to take blood for altruistic blood tests ( to test for blood borne virsues) from a patient who is unable to give consent, an order from a senior authorized medical officer must be issued under section 134. The form can be found in the Guidelines for post-incident testing orders and Authorisations Part 8 , Division 5 of the Health and Wellbeing Act 2008. Legally this would be a more appropriate option in the situation you have outlined.
Cathy Mowat
Infection Control
Central Gippsland Health Service
0351438518
cathy.mowat@cghs.com.au
SaleHi All,
I would like some advice from the group on gaining informed consent from the source of a blood and body fluid exposure and timeliness of bloods being sent for testing, in particular if the patient is aneasthetised.
Our current situation:
On our generic consent form for procedures it has a ‘sentence’ regarding bloods being taken from them whilst anaesthetised for the purpose of testing re if there is a needlestick injury during their procedure. I have never been comfortable with this as there is no risk assessment, discussion regarding what tests or how we keep that information confidential. Although there has been a signed consent, I do not see it as an informed consent. Also if Drs use their own consent forms this ‘sentence’ is not included.
If we wait 24 hours post anaesthetic then potentially you could miss the window for administration of post exposure prophylaxis .
If the patient is not anaesthetised then the management is completed using a signed consent and discussion regarding results of tests with treating Dr or infection control.
Thank you for your assistance in advance
Kind Regards
Nicola Swindells
Infection Control /Quality and Risk Manager
Mater Hospitals Central Queensland
Rockhampton Yeppoon Gladstone
nswindells@mercycq.com
07 49313420This email does not necessarily constitute an official representation of Mercy Health and Aged Care Central Queensland Limited. Any unauthorised use of the email or contents is strictly prohibited. Emails may be interfered with, may contain computer viruses or other defects and may not be successfully replicated on other systems. It is your responsibility to scan this message and any attachments for computer viruses or other defects and Mercy Health and Aged Care Central Queensland Limited gives no warranties in relation to these matters.
Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.
You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au
Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
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Hi Cathy
Interesting that Victoria has legislation that covers this. I am not aware of any similar legislation in Queensland where Nicola is based.
Cheers
MichaelMichael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
Please consider the environment before printing this emailNicola, my understanding is that under the 2008 Health and Wellbeing Act to take blood for altruistic blood tests ( to test for blood borne virsues) from a patient who is unable to give consent, an order from a senior authorized medical officer must be issued under section 134. The form can be found in the Guidelines for post-incident testing orders and Authorisations Part 8 , Division 5 of the Health and Wellbeing Act 2008. Legally this would be a more appropriate option in the situation you have outlined.
Cathy Mowat
Infection Control
Central Gippsland Health Service
0351438518
cathy.mowat@cghs.com.au
SaleHi All,
I would like some advice from the group on gaining informed consent from the source of a blood and body fluid exposure and timeliness of bloods being sent for testing, in particular if the patient is aneasthetised.
Our current situation:
On our generic consent form for procedures it has a ‘sentence’ regarding bloods being taken from them whilst anaesthetised for the purpose of testing re if there is a needlestick injury during their procedure. I have never been comfortable with this as there is no risk assessment, discussion regarding what tests or how we keep that information confidential. Although there has been a signed consent, I do not see it as an informed consent. Also if Drs use their own consent forms this ‘sentence’ is not included.
If we wait 24 hours post anaesthetic then potentially you could miss the window for administration of post exposure prophylaxis .
If the patient is not anaesthetised then the management is completed using a signed consent and discussion regarding results of tests with treating Dr or infection control.
Thank you for your assistance in advance
Kind Regards
Nicola Swindells
Infection Control /Quality and Risk Manager
Mater Hospitals Central Queensland
Rockhampton Yeppoon Gladstone
nswindells@mercycq.com
07 49313420This email does not necessarily constitute an official representation of Mercy Health and Aged Care Central Queensland Limited. Any unauthorised use of the email or contents is strictly prohibited. Emails may be interfered with, may contain computer viruses or other defects and may not be successfully replicated on other systems. It is your responsibility to scan this message and any attachments for computer viruses or other defects and Mercy Health and Aged Care Central Queensland Limited gives no warranties in relation to these matters.
Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.
You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au
Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.
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________________________________
Message protected by MailGuard: e-mail anti-virus, anti-spam and content filtering.
http://www.mailguard.com.auReport this message as spam
—
WARNING : This email contains information, which is CONFIDENTIAL, and that maybe subject to LEGAL PRIVILEGE. This e-mail and any attachments to it (the “Communication”) is confidential and is for the use only of the intended recipient, and may not duplicated or used by any other party without the express consent of the sender. The Communication may contain copyright material of St Vincent’s Health & Aged Care(“SVHAC”), or any of its related entities or of third parties. If you are not the intended recipient of the Communication, please notify the sender immediately by return e-mail, delete the Communication, and do not read, copy, print, retransmit, store or act in reliance on the Communication. Any views expressed in the Communication are those of the individual sender only, unless expressly stated to be those of SVHAC. SVHAC does not guarantee the integrity of the Communication, or that it is free from errors, viruses or interference. Thank-you.Message protected by MailGuard: e-mail anti-virus, anti-spam and content filtering.
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Hi Nicola
I am replying on behalf of Janet as she is currently on leave. We recently updated our policy for exposure management as well as the consent form for source pathology. Hopefully the policy will be of help to you.
regards
Belinda Meehan RN B Nurs M Nurs (AP) M WIMOR
Clinical Nurse Consultant | HNEMH Staff Health
P.O. Box 833 Newcastle NSW 2300
Tel 02 4033 5016 | Fax 02 4033 5019 | Mob 0408 400 328 | Belinda.Meehan@hnehealth.nsw.gov.au
http://www.health.nsw.gov.au[cid:image001.jpg@01CE9449.46BBCF80]
Conjoint Fellow
School of Nursing and Midwifery
Faculity of Health
University of Newcastle
[cid:image002.jpg@01CE9449.46BBCF80]Hi All,
I would like some advice from the group on gaining informed consent from the source of a blood and body fluid exposure and timeliness of bloods being sent for testing, in particular if the patient is aneasthetised.
Our current situation:
On our generic consent form for procedures it has a sentence regarding bloods being taken from them whilst anaesthetised for the purpose of testing re if there is a needlestick injury during their procedure. I have never been comfortable with this as there is no risk assessment, discussion regarding what tests or how we keep that information confidential. Although there has been a signed consent, I do not see it as an informed consent. Also if Drs use their own consent forms this sentence is not included.
If we wait 24 hours post anaesthetic then potentially you could miss the window for administration of post exposure prophylaxis .
If the patient is not anaesthetised then the management is completed using a signed consent and discussion regarding results of tests with treating Dr or infection control.
Thank you for your assistance in advance
Kind Regards
Nicola Swindells
Infection Control /Quality and Risk Manager
Mater Hospitals Central Queensland
Rockhampton Yeppoon Gladstone
nswindells@mercycq.com
07 49313420This email does not necessarily constitute an official representation of Mercy Health and Aged Care Central Queensland Limited. Any unauthorised use of the email or contents is strictly prohibited. Emails may be interfered with, may contain computer viruses or other defects and may not be successfully replicated on other systems. It is your responsibility to scan this message and any attachments for computer viruses or other defects and Mercy Health and Aged Care Central Queensland Limited gives no warranties in relation to these matters.
Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.
You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au
Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.
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