What is the protocol for obtaining informed consent for blood transfusion?

Protocol for Obtaining Informed Consent for Blood Transfusion

Blood transfusion requires documented informed consent that includes discussion of risks, benefits, and alternatives with the patient before the procedure, except in emergency situations where consent cannot be obtained.

Key Elements of the Informed Consent Process

Timing and Setting

• Informed consent for blood transfusion should be obtained and documented before the procedure whenever possible 1
• The discussion should take place in the absence of factors that could unduly influence the patient's decision 1
• Where blood transfusion is anticipated before surgery, this should be discussed during pre-assessment and valid consent documented 1

Essential Information to Provide

• Explanation of why the transfusion is needed and the specific benefits for the patient's condition 1
• Individualized risks, benefits, and expected outcomes of the transfusion 1
• Potential risks of transfusion including transfusion reactions, infections, and other adverse events 1
• Available alternatives to allogeneic blood transfusion where applicable (e.g., cell salvage, autologous donation) 1
• How the transfusion will be administered and monitored 1

Documentation Requirements

• The consent process must be clearly documented, including the patient's agreement to the intervention and the discussions that led to that agreement 1
• Documentation should include the patient's questions and the responses given 1
• This can be done on a standard consent form, on the anaesthetic record, or separately in the patient's notes 1
• Some institutions may have specific transfusion consent forms that should be used according to local policy 1

Special Considerations

Qualified Consent

• Some patients may qualify their consent by refusing specific aspects of treatment (e.g., Jehovah's Witnesses may refuse homologous blood but accept cell salvage) 1
• If a patient gives qualified consent, document in the hospital notes that they have been informed of the likely consequences of this decision 1
• Note the precise nature of the restriction imposed by the patient and the explanation of risks that took place 1
• Draw attention to the clause on the consent form that specifies the patient's right to list procedures for which consent is not agreed 1

Emergency Situations

• All hospitals should have a clear policy for transfusion of patients whose identity is unknown or in emergency situations 1
• In emergencies when consent cannot be obtained, this should be documented and the rationale for proceeding without consent clearly stated 1
• When possible, inform patients afterward that they have received blood components 1

Ensuring Patient Understanding

• Confirm the patient's capacity to provide informed consent before proceeding 1
• Verify the patient's understanding of the information provided about risks and benefits 1, 2
• Consider using standardized educational materials such as information leaflets or videos to supplement verbal explanations 2, 3
• Allow adequate time for patients to consider information and ask questions 1, 4

Common Pitfalls to Avoid

• Incomplete information: Studies show that risks are less frequently discussed than benefits during consent discussions 5, 3
• Inadequate verification of understanding: Patients often have variable and incomplete recall of information provided during consent discussions 2, 5
• Failure to document: Ensure all aspects of the consent discussion are properly documented, as this is a legal requirement 1
• Not informing patients post-transfusion: Patients should be informed that they have received blood components before discharge, as they may otherwise be unaware 1
• Rushing the process: Allow sufficient time for patients to process information and make an informed decision 1, 4

Practical Implementation

• Consider implementing standardized consent protocols with key points to cover 6, 4
• Provide educational resources such as leaflets at bedsides, in pre-op packs, and in outpatient clinics 3
• Ensure all staff involved in obtaining consent for blood transfusion are properly trained and competency-assessed 1
• Use clear, non-technical language appropriate to the patient's level of understanding 2, 4
• Inform the patient's general practitioner that they have received blood components 1