What are the key points to consider when consenting a patient for blood transfusion?

Key Points When Consenting a Patient for Blood Transfusion

When obtaining consent for blood transfusion, healthcare providers must discuss anticipated transfusions with patients before surgery, document valid consent, and ensure patients understand the risks, benefits, and alternatives to transfusion. 1, 2

Pre-transfusion Discussion Requirements

• Blood transfusion should be discussed with the patient before surgery whenever transfusion is anticipated, with valid consent documented in the patient record 1
• The consent discussion must take place in an environment free from undue influence on the patient's decision-making process 2
• Information provided should be tailored to what this particular patient would consider relevant when making their decision 1
• Written information should be available in appropriate languages and formats (including Braille and large-print for visually impaired patients) 1
• Professional interpreters (not family members) must be used for patients who don't speak English to ensure accuracy of information and reduce coercive influence 1

Essential Content of Consent Discussion

• Explanation of why the transfusion is needed and the specific benefits for the patient's condition 2
• Individualized risks and benefits of transfusion including potential adverse events such as:
  • Transfusion reactions (tachycardia, rash, breathlessness, hypotension, fever) 1
  • Potential for infections and other complications 2
• Available alternatives to allogeneic blood transfusion where applicable (e.g., cell salvage, autologous donation) 1, 2
• Information that receiving blood components removes patients from the donor pool 1
• Expected outcomes with and without the transfusion 3

Documentation Requirements

• The consent process must be clearly documented, including the patient's agreement and the discussions that led to that agreement 1, 2
• Documentation can be on a standard consent form, the anesthetic record, or in the patient's notes 2
• Include the patient's questions and the responses given 2
• All prescriptions for transfusion must be documented in the patient record (anesthetic chart or drug/fluid prescription chart) 1

Special Considerations

Qualified Consent

• Some patients may qualify their consent for religious or personal reasons (e.g., Jehovah's Witnesses) 1
• If a patient gives qualified consent, document in hospital notes that they have been informed of likely consequences of their decision 1
• Note the precise nature of any restrictions imposed by the patient and the explanation of risks that took place 1
• Qualified consent does not remove a patient's right to reasonable and proper care 1

Advance Decisions

• Check whether a patient has made a relevant advance decision to refuse treatment 1
• An advance decision that is valid and applicable to the treatment in question is legally binding 1

Emergency Situations

• All hospitals should have a clear policy for transfusion of unidentified patients 1
• In emergencies, patients should have identification attached stating "unknown male/female" and a unique identification number 1
• If the patient's identity becomes known, new identification must be attached and a new transfusion sample collected 1

Post-transfusion Information

• Patients should be informed that they have received blood or blood components before discharge from hospital 1
• The patient's general practitioner should be informed about the transfusion 1

Monitoring for Adverse Events

• Clinical observations should include heart rate, blood pressure, temperature, and respiratory rate (minimum of pre-transfusion, at end of transfusion, and 15 minutes after transfusion) 1
• If signs of a transfusion reaction occur, stop the transfusion immediately and contact the laboratory 1
• Management of reactions may include antihistamines, steroids, or intramuscular/intravenous adrenaline if life-threatening 1

Common Pitfalls to Avoid

• Failing to perform proper identity checks between the patient and blood to be transfused, which is the most common cause of serious transfusion errors 1
• Not providing sufficient information about risks, as studies show this often doesn't happen routinely 4, 5
• Discussing important risks (such as transfusion-related acute lung injury) too infrequently 5
• Not utilizing available patient information leaflets, which can effectively supplement verbal information 4
• Assuming a single consent covers multiple transfusion episodes when significant changes in the patient's condition have occurred 3