Re: Patient consent post anaesthetic for Body Fluid Exposure Bloods

[Donna Cameron]

Hi Sara,

Further to what Margaret has said.

In Victoria, a health service has the ability to appoint an Authorised Senior Medical Officer (ASMO) who is able to give consent on behalf of someone who is unable to provide consent (or is deceased) in either a temporary capacity (e.g. anaesthesia) or more permanently (e.g. dementia). If a health service does not have an ASMO then an application to the Chief Health Officer (CHO) can be made for testing. The preference is for health services to have an appointed ASMO. A spouse, next of kin or other person capable of consenting on behalf of the person unable to consent cannot consent or refuse consent in this circumstance (this is according to the guidance provided by DHHS). Parents, however, are able to consent to the testing of their child where the child is considered not to have capacity. Only the CHO can make an order to test if someone has refused to be tested. This is under Part 8, Division 5 of the Public Health and Wellbeing Act 2008 (the post-incident testing provisions).

This guidance can be found here: https://www2.health.vic.gov.au/public-health/chief-health-officer/cho-publications/guidelines-for-post-incident-testing-orders-and-authorisations

When I previously worked in a large tertiary hospital in Melbourne, how this worked in practice was that the ID Registrars became the Authorised Senior Medical Officers (there was a process to authorise them for this). We would contact the ASMO if a patient (source) was unable to consent. After discussion of the case the ASMO would (usually) provide consent (a form was signed documenting this) and the patient either had blood taken and tested or blood already in the lab was tested. Occasionally, if the incident was considered lower risk (e.g. splash vs NSI) and the patient was temporarily unable to consent (most likely under general anaesthesia) the ASMO would request that we wait for the patient to come out of the anaesthetic and we would obtain consent directly from the patient. We didn’t wait for 24 hours or any other specified time period. Just until they appeared to be alert and could reasonably talk to us. We also did not have it on our consent forms for surgical procedures that they could be tested if an exposure incident were to occur.

I realise that you are in QLD so this is not strictly relevant to you, but you may want to clarify if there is anything similar to the above legislation in QLD. Perhaps you should contact your legal person/department and ask for their opinion, after all if something goes horribly wrong it will be the lawyers who ultimately tell you what you should have done.

Regards,
Donna

Donna Cameron
Infection Control Consultant
T +61 (0) 3 8344 3574 (Monday, Wednesday & Friday); +61 (0) 3 9096 5233 (Tuesday & Thursday)
donna.cameron@unimelb.edu.au
Microbiological Diagnostic Unit Public Health Laboratory
The Peter Doherty Institute for Infection and Immunity
792 Elizabeth Street | Melbourne | Victoria | Australia | 3000
doherty.edu.au

Fri
Dear Sara the last seminar I attended that addressed this exact tropic (3 years ago from memory) in Melbourne was that the CMO of Vic could authorise blood to be collected even while pt not able to give consent or even refuse consent

I would be happy to be updated or be told I am incorrect but it’s what I refer to when presenting

Regards,

Margaret Jennings
Marjen Education Services

website. http://www.marjenes.com.au
email. marjenes@optusnet.com.au

mob. 0404 088 754
fax. 03 9439 2436

Afternoon Brains Trust,

I am trying to update our Body Fluid Exposure consent process for patients.

If the patient has not consented to the collection of Hep B, C & HIV prior to surgery, I was lead to believe that we had to wait 24 hrs post an anaesthetic for the consent to be valid, however I do not have any written evidence to back this up. I have also been told today that this is no longer correct.

Are you able to direct me or provide any assistance with the correct information in relation to this.

Many thanks for any assistance you can provide

Regards

Sara

Sara Godden CICP
Infection Control Coordinator
Acting Stomal Therapy Nurse

Brisbane Private Hospital
259 Wickham Terrace, Brisbane QLD 4000
T (07) 3834 6771 | M 0404 821 418 | F (07) 3834 6234
E sara.godden@healthscope.com.au
Website http://www.brisbaneprivatehospital.com.au

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