For 11 years our PICC service RNs (San Francisco) have done their own 'Informed Consent' prior to placing PICCs. This only made sense as we know the risk factors and I consider it my responsibility to make sure they are fully informed prior to placing a line. Recently our Risk management team told us that it is not within our scope of practice as RNs to do the informed consent so the MDs who has never placed a PICC and in many cases (being a teaching hospital) are not aware of all the risk factors will be required to do the consent.
Can anyone provide information that I can present to our Risk Management team to prove why the inserter, RN is covered to do the 'Informed Consent'. Or is it true what they say about Informed Consent being outside our scope of practice as RNs in California.
Does anyone have any information?
My understanding is that informed consent is established by rules and regulations from the state of CA. I am not sure what agency or board at the state level sets these rules but the only way to change this is to change those rules. You can show your RM the INS standards of practice which state that the person performing the procedure is the one responsible for informed consent. But this will not change those state rules. It is not a matter of scope of practice. It is these state rules you are dealing with. The other approach is to call it education instead of informed consent and to document the patient teaching and their achievement of established learning objectives. You could even have them sign a form stating their understanding of what you have taught them. Informed consent is a practice established by physicians for physicians. So call it by another name and do an end-run around these rules. The outcome is the same - the patient is taught what they should know. 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
Thank you Lynn, as usual for your knowledge and expertise!
SOD
We were also in the same place. Working in PA. it also is not within our scope of practice to obtain informed consent. So we(2 PICC nurses) developed our own consent for the physician who ordered the PICC to obtain.
Send me your e:mail address and I would be happy to send to you.
Sue,
Thank you - I would appreciate it if you would send me that consent you created. I meet with RM soon to find out why this change is being made after 11 years - it might be something new with CA law. My email is : <[email protected]>
SOD
We are in the same boat in terms of scope of practice in SC. We developed an education tool just as Lynn describes, and it is treated as a consent by us, even though it is for educational purposes. email me if you would like a copy. Be glad to share. [email protected]
Cheryl E. Aldo, RN, BS VA-BC
Hello,
I am not sure if this is helpful but on our form it states that the practitioner responsible for the procedure is to obtain consent. Since we are the practitioners (RNs), we obtain our own consent. One of the legal stipulations under discussion was not to discuss "alternatives" to the PICC insertion, such as when we think of the BAR statements (benefits, alternatives, risks). The group felt "alternatives" was making a medical decision about what was best for the patient, when we are not really doing that now, but that decision was made, i.e. to place a PICC. These forms are newer, within the past year. If I could figure out how to attach a file I can scan one here for the group; I don't see an "attach file" for the posting.
Carole