What is the proper procedure for obtaining informed consent for a blood transfusion?

Proper Procedure for Obtaining Informed Consent for Blood Transfusion

Informed consent for blood transfusion must include documentation of the patient's agreement to the intervention and the discussions that led to that agreement, including specific risks, benefits, and alternatives to transfusion. 1

Documentation Requirements

• Use a standard consent form or document in the patient's notes:

  • Patient's full name
  • Hospital number
  • Date of birth
  • Date and time of consent discussion
  • Name of the person obtaining consent 1, 2

• The consent documentation should clearly record:

  • Purpose and benefits of transfusion
  • Potential risks of transfusion
  • Available alternatives to transfusion
  • Patient's questions and the responses given 1, 3

Essential Elements of the Consent Discussion

Risks to Discuss

• Febrile non-hemolytic transfusion reactions
• Allergic reactions
• Transfusion-associated circulatory overload (TACO)
• Transfusion-related acute lung injury (TRALI)
• Infection transmission risks (viral, bacterial)
• Iron overload (for chronic transfusions)
• Immunological complications 2, 4

Benefits to Discuss

• Increased oxygen-carrying capacity
• Volume replacement
• Clotting factor replacement
• Specific clinical indications for the individual patient 2, 4

Alternatives to Discuss

• Cell salvage techniques
• Acute normovolaemic hemodilution
• Pharmacological alternatives (e.g., erythropoietin)
• Non-intervention (and its consequences) 1, 2

Special Considerations

Qualified Consent

For patients who may refuse specific aspects of treatment (e.g., Jehovah's Witnesses):

• Document that the patient has been informed of likely consequences of their decision
• Record the precise nature of any restrictions imposed by the patient
• Note the explanation of risks that took place
• Highlight the clause on the consent form that specifies the patient's right to list procedures for which consent is not agreed 1

Transgender and Gender-Diverse Patients

• Report transgender status to the hospital's blood transfusion service (with patient's consent)
• Follow local health board policies regarding blood sampling and transfusion
• Be aware that the blood transfusion service will identify patients based on the sex documented on their sample form 1

Common Pitfalls and How to Avoid Them

1. Incomplete risk disclosure

   • Many physicians fail to discuss important risks like TRALI 4
   • Solution: Use a standardized checklist of risks to ensure comprehensive coverage

2. Poor patient recall and understanding

   • Only 35% of patients feel better informed after consent discussions 5
   • Solution: Provide written materials or educational videos to supplement verbal information 6

3. Inadequate documentation

   • Failure to document specific risks discussed and patient's questions 1
   • Solution: Use structured consent forms with specific sections for risks, benefits, and alternatives

4. Rushed consent process

   • Consent obtained without adequate time for patient questions 4
   • Solution: Allow sufficient time for discussion and questions; consider obtaining consent in advance when possible

5. Failure to address specific patient concerns

   • Not exploring individual patient worries about transfusion 6
   • Solution: Ask open-ended questions about the patient's specific concerns

Practical Approach to Obtaining Consent

1. Choose an appropriate setting (private, quiet, with adequate time)
2. Explain why transfusion is recommended for the specific clinical situation
3. Discuss the main risks and benefits relevant to the patient
4. Discuss reasonable alternatives
5. Invite and answer questions
6. Document the discussion comprehensively
7. Ensure the patient understands that while all practicable steps have been taken to ensure safety, a zero-risk blood supply is impossible 7
8. Obtain signature on consent form or document verbal consent in notes

By following this structured approach to obtaining informed consent for blood transfusion, clinicians can ensure patients are properly informed about this common but potentially risky intervention, ultimately improving patient autonomy and satisfaction with the consent process.