I would love to get a legal view of this situation:
What would be the approriate action to take for a patient who is "normally" A&O x3 but now with an infection, is very confused and a PICC needs to be placed for four weeks of IVAB?
Pt is his own responsible party according to the chart, but they list the Wife as the emergency contact.
Would you, as a Vascular Access Specialist, be "okay" in reading the risks and benefits and then obtaining consent from the Wife?
Wife readily admits that she is not her husband's POA.
Please advise.
Thank You.
I would want Ann Zonderman to provide more information, but I can add that I have never seen a lawsuit where the lack of informed consent in the form of a signed document was the only issue in a case. There are numerous issues with informed consent. In the absense of a signed healthcare power of attorney, the common practice is to obtained consent from the next of kin. It appears to me that would be the wife. Remember that informed consent requires knowledge of the procedure, reason for it, risks, benefits, and alternatives. The wife would need time to ask questions and simply reading the information and expecting a signature may not be obtaining a true informed consent. If the patient is to be discharged with the PICC and meds, the wife will be part of the plan of care. An actual complication with negative outcomes and actual damages is required for a successful lawsuit. The circumstances of the informed consent could become an issue in the event of a serious complication with damages. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Ann here..... Disclaimer --- Not legal advice, merely an opinion of a legally educated RN, JD, CRNI
I would agree with Lynn, the next of kin would be the person to discuss all the facts and ask for consent...Be sure the next of kin are not estranged... and also consider:
If the patient has never discussed such issues with family, then it is open to kin to decide. If the patient is know to have voiced preferences they should be part of the decision making process.
If next of kin wants no part of the decision, a medical need (by the treating physician (s) decision may be the next option.
Ann Zonderman, BSN, JD, CRNI
Thank you two for your replies. The setting is LTC, and I'm concerned that if that patient DID NOT designate anyone to make these decisions for him or her, and I "go around the pt" and get consent for the procedure from a S/O or relative and something goes wrong, could that pt come back to me and charge me with the complication, but also Assault and Battery for doing something to him that he gave NO consent for?
If the prescribed antibiotic is non-irritant, and pH appropriate for a PIV, why not place a one (or a midline), allowing for the medication to take effect, and the resident's condition improving. This may but time till he is able to make his own decision.
Ann Zonderman, BSN, JD, CRNI
A catheter complication alone does not mean a successful lawsuit. There must be damages from that complication. Say you hit a nerve, patient complained of paresthesia and you continued the procedure. Or you put it in the artery instead of the vein, did not do a correct assessment, continued infusion therapy and the patient had an air emboism which went to his brain causing neurological damage like a stroke. Those are the types of things that procedure a successful lawsuit. So a complication like a bloodstream infection that is treated without any longer term damages, or a DVT that does not produce any permanent damages will not be successful as a lawsuit. Of course, anyone can bring a lawsuit for any reason, but no attorney is going to waste time on a lawsuit without damages - it is not financially beneficial for the attorney. Ann is correct that you should have already done a thorough assessment for the most appropriate type of VAD for this patient and it may not be a PICC if a midline will work.
Whose policy is requiring the signed consent? Your company or the nursing home? Some are now saying that the general consent signed upon admission is sufficient for all these procedures. You have to do what is the best for the patient. If the patient's therapy requires a PICC and the patient's next of kin will sign the required form, you should proceed with insertion because that is in the best interest of the patient. We can't have the fear of lawsuits dictate what care we do or do not provide. The lawsuits involving PICCs that I have reviewed have not included any situation surrounding the presence or absence of a signed consent form. They have all been clear negligence on the part of the inserter that produced permanent damage for the patient such as air emboli and CVA, or arm amputation in a case of arterial placement in an infant or complex regional pain syndrome from nerve damage. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Hi Diane,
Informed consent is something that I am a stickler on but I am not an attorney. Our hospital has a policy that spells out the hierachy of who would provide the informed consent if the patient is unable to. It also describes the process of involving the ethics committee when the patient has no one in their life to provide the consent. In the case of a real emergency (usually not the case with PICC insertion) two physicians can sign the consent form but I do not take this loosely, it MUST be an emergency. Case managers are of great assistance and usually have insight into the patient's history in order to drum up family members. Here is the hierarchy we use:
POA
court appointed guardian
spouse (unless legally separated)
adult child (if more than one, a majority consensus)
parent
domestic partner
sibling
close friend (actively involved in patient's care or willing to become actively involved)
physician consults ethics committee
two physicians if ethics committee is not feaseable (e.g. emergency)