Showing posts with label surgical consent. Show all posts
Showing posts with label surgical consent. Show all posts

Monday, December 2, 2013

Organ Donation Informed Consent, Is A Single Parent's Sufficient? #nursingcasestudy #nursefriendly #healthcare #organdonation

Organ Donation Informed Consent, Is A Single Parent's Sufficient? #nursingcasestudy #nursefriendly #healthcare #organdonation
Organ donors are in high demand.  Frequently intended recipients can wait a lifetime for the critical matching organ.  In this case, two nurses obtained a consent from a child's mother.  When the father later expressed his disagreement, the child's corneas had been harvested and it was too late. 
Andrews v. Alabama Eye Bank, 727 S. 2d 62 AL (1999)
http://www.nursefriendly.com/nursing/clinical.cases/062099.htm 

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Wednesday, April 6, 2011

Organ Donation Informed Consent, Is A Single Parent's Sufficient? Nursing Malpractice Cases

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Summary:  Organ donors are in high demand.  Frequently intended recipients can wait a lifetime for the critical matching organ.  In this case, two nurses obtained a consent from a child's mother.  When the father later expressed his disagreement, the child's corneas had been harvested and it was too late.

The patient was an 11-year-old child that had died soon after an Asthma attack.

"By condition (excluding pregnancy), the five leading causes of hospitalization among children are: bronchitis/asthma, digestive disease, pneumonia and respiratory infection, otitis media and mental disorders."1

The parents were approached for the purpose of donating the child's corneas under the Uniform Anatomical Gift Act.

"What is a Corneal Transplant?

The cornea is a dime-sized clear tissue covering the front of the eye. Light rays pass through the cornea and then through the lens. The lens forms an image on the retina in the back of the eye where the optic nerve is located. Sight is controlled by the optic nerve, the only nerve of vision. This nerve activates the retina to pick up the image in view."2

The mother alone was present at this time when it was first discussed.

"The child's mother maintains that she told the nurse it "did not matter" to her."3

"The Uniform Anatomical Gift Act (UAGA) of 1968 provided for the first time that an individual could donate his or her organs at death to another for medical purposes. It was adopted in all 50 states and the District of Columbia, and was a major step toward solving the organ donation problem. But new medical technologies have now made many transplant operations commonplace, and a shortage of donor organs remains."4

With this, the harvesting center was contacted and the patient's information left.  A consent form was faxed over to the hospital.  Two nurses then spoke to the mother by telephone and signed off on the form that consent had been obtained.

Individual state laws may vary in procedure for who can consent to an anatomical gift.  In Alaska for instance:

"(a) A competent person who is 18 or more years of age may make a gift to take effect upon death of all or a part of the person's body for a purpose specified in AS 13.50.020.

(b) When persons in prior classes are not available at the time of death, and in the absence of actual notice of contrary indications by the decedent or actual notice of opposition by a member of the same or a prior class, any of the following persons, in order of priority listed, may give all or a part of the decedent's body for a purpose specified in AS 13.50.020:

(1) the spouse;
(2) an adult son or daughter;
(3) either parent;
(4) an adult brother or sister;
(5) a guardian of the decedent at the time of death;
(6) any other person authorized or under obligation to dispose of the body.
(c) The persons authorized by (b) of this section may make the gift after or immediately before death."5

The agent for the organ center came and harvested the child's corneas and returned to the center.  He had looked over the consent form obtained, initialed it to verify it had been obtained by phone and was satisfied.

"When the cornea, a thin tissue that covers the front of the eye, becomes cloudy or damaged due to disease, injury or hereditary conditions, the result is vision loss or even blindness.

To clear this window, the damaged cornea is removed surgically and replaced with healthy, transplanted eye tissue-a donated cornea. This transplant operation is successful in more than 90 percent of cases in the US. After a successful transplant, patients have renewed vision or see for the first time."6

Each individual facility must generate protocols on organ procurement and obtaining informed consent:

"Each hospital in the state shall develop procedures for identifying potential donors of gifts, requesting gifts, notifying and coordinating with eye banks, tissue banks, and organ procurement agencies, and assisting in the procurement, removal, storage, and transportation of gifts."7
 

The child's father would arrive on the scene soon after.  When approached and informed of the harvesting, he was perturbed.  He would not sign the consent after the fact and chose to take legal action against the hospital and the donor center.

In court, summary judgement was entered for the defense:

The parent's appealed.

Questions to be answered:

1. Under the Uniform Anatomical Gift Act (UAGA), is the consent of a parent sufficient to proceed with harvesting of a child's organs.

2. Were the nurses negligent in their explanation of the procedure or in not waiting till the father was available?

The applicable laws stated that as long as a consent from a legally "responsible" and informed party is obtained, no liability or negligence can be assigned.  It was clear from the testimony of the nurses that they spoke to the mother and informed her of what was to happen.

In obtaining organs, time is typically of the essence.  The longer an organ or tissues remains in a body, the less likely it will be useful for the purposes of transplantation.

There was no evidence that the mother was either "coerced" or "rushed" into making a decision.  There was no documentation that she "wished to speak to her husband" before making the decision.  If more time had been needed or another family member needed to be consulted, the mother could have clearly stated this.

On the part of the nurses, a single adult guardian consent only was needed and obtained.

When the agent of the eye bank looked over the informed consent, he as satisfied that it was legitimate.  In harvesting the child's corneas, he acted in good faith and had no reason to believe a proper consent had not been obtained.

The court dismissed the plaintiff's argument that the "good faith" actions of the hospital or eyebank were "subject to interpretation."  The court was satisfied that under the conditions, the actions of the employees were reasonable and within the boundaries of existing law.

This case does point out the need for judgement and clear documentation when a consent for organ donation is obtained.  The nurses were wise to obtain not one but two witness signatures on the consent form.  The agent of the eye bank was wise to make sure the notation was made of a "telephone" consent.

Regardless of these precautions, the nurses, hospital and eyebank were still sued.  Had this lawsuit been initiated after either of the employees involved had left, the hospital may or may not have covered or defended them.

Related Link Sections:

Clinical Charting and Documentation, Nurses Notes
http://www.nursefriendly.com/nursing/linksections/directpatientcarelinks.htm

Informed Consent
http://www.legalnursingconsultant.org/legal.nurse.consultants.lnc/informed.co...

Medical Legal Consulting Nurse Entrepreneurs
http://www.nursefriendly.com/nursing/ymedlegal.htm

Organ Donation:
http://www.nursefriendly.com/nursing/directpatientcare/organ.tissue.donation.htm
 

Sources:

1. National Association of Children's Hospitals and Related Institutions.  No date given. About Childrens Hospitals - Facts on Children's Health - Illness and Injury.  Retrieved June 20, 1999 from the World Wide Web: http://www.nachri.org/abouth/facts/hlth_illness.html

2. Old Dominion Eyebank.  No date given.  Corneal Transplant. Retrieved June 20, 1999 from the World Wide Web: http://www.odeb.org/html/cornealtransplant.htm

3. RRNL 39 May 12 (1999)

4. National Conference of Commissioners on Uniform State Laws.  No date given.  Why All States Should Adopt The Revised Uniform Anatomical Gift Act (1987). Retrieved June 20, 1999 from the World Wide Web: http://www.nccusl.org/whystate/uagawhy.html

5. The Alaska Legal Resource Center. No date given.  Persons Who May Execute An Anatomical Gift.  Retrieved June 20, 1999 from the World Wide Web:  http://www.touchngo.com/lglcntr/akstats/Statutes/Title13/Chapter50/Section010...

6. Medical Eye Bank of Florida.  No date given.  Anatomy of the Eye. Retrieved June 20, 1999 from the World Wide Web: http://www.castlegate.net/mebfl/anatomy.htm

7. The Alaska Legal Resource Center. No date given. Requests By Hospitals For Anatomical Gifts. Retrieved June 20, 1999 from the World Wide Web: http://www.touchngo.com/lglcntr/akstats/Statutes/Title13/Chapter50/Section014...
 

The Uniform Resource Locator (URL) or Internet Street Address of this page is
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Send comments and mail to Andrew Lopez, RN

Created on Saturday May 23, 1999

Last updated by Andrew Lopez, RN on Monday, February 28, 2011

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Friday, November 12, 2010

Hospitals try high-tech to better inform patients - San Jose Mercury News

Click photo to enlarge
In this photo taken Oct. 29, 2010, Kristen Miller, a colonoscopy... ((AP Photo/Brian Kersey))
CHICAGO—Learning he had prostate cancer floored John Noble. Then came the prospect of surgery and his overpowering fear of being "put under" with anesthesia.

Remarkably, he found comfort in a computer. A soothing woman's voice explained the operation step-by-step, its risks and benefits, and even answered his questions. Noble's phobia vanished. The operation to remove his tumor was uneventful and Noble is doing fine.

The 54-year-old Pennsylvania lawyer was aided by an interactive computer program that is part of a growing trend in health care, helping patients better understand what they are consenting for the doctor to do.

Proponents say this way of getting informed consent makes patients partners in decision-making.

Such a system "sends a message that the decisions are truly owned by the patients," said Dr. Harlan Krumholz, a Yale University heart specialist and advocate of changing informed consent procedures.

Computer-based informed consent programs are also part of a broader push for electronic record-keeping that President Barack Obama's administration has advocated to improve patient safety and curb medical errors.

The Emmi Solutions program that John Noble watched about prostate cancer surgery can be viewed at home, and that's where Noble watched it.

Shortly after his diagnosis last December, while he was still grappling with shock and denial, his doctor e-mailed him the program.

"I put off watching it for a

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while," he said. "Who wants to be filled in on the facts of the surgery? Ultimately I forced myself to review it when I was all alone."

By the time he watched it, he felt better prepared mentally than when his doctor first told him he had cancer.

Noble said his biggest fear "was being knocked out. I was terribly afraid of it."

As the interactive explained the operation, Noble could pause it and ask questions or review the information to make sure he understood it.

"It changed my perspective. It removed my fear," he said.

Traditionally, informed consent has involved a conversation with the doctor and signing medical forms written in tough-to-decipher legalese.

It has a dual purpose: to make sure patients understand risks and benefits, and to protect hospitals from lawsuits in case something goes wrong.

Even for someone with a law degree, like Noble, that process can be dizzying in the emotional aftermath of a scary diagnosis.

Research shows patients often have no clue about what they just signed and may end up totally uninformed about why a procedure is being recommended or how it might help or hurt them.

Chicago-based Emmi Solutions has developed programs used in more than 100 hospitals, including the University of Pittsburgh Medical Center, where Noble had his surgery.

Dialog Medical in Atlanta makes another popular informed consent program, iMedConsent, used by more than 190 U.S. hospitals. It's designed for doctors and patients to go over together. Versions written for patients with a sixth-grade reading level are available.

The Department of Veterans Affairs now requires its doctors to use iMedConsent programs for all procedures needing informed consent. The VA estimates it will receive 2.6 million consent forms this year from patients who used the program.

Dr. Ellen Fox, the VA's chief health care ethics officer, recalls a patient who watched the program with his doctor before having a repeat test to see if his bladder cancer was back. Afterward, the man told his doctor he thought he would be having the same test he had four times before.

It was the same test. "But for the first time, the patient really understood what was going to be done to him," Fox said.

"In order to make informed choices about health care, patients need complete and accurate information," Fox said.

"It is ultimately the patient's choice" whether to have a procedure. It's just that patients may not realize they have a choice. The program helps make that clear, she said.

The University of Chicago Medical Center recently began requiring new patients referred for colonoscopies to watch an Emmi program, with hopes that it will reduce the no-show rate.

Kristen Miller, 29, an online marketer with an intestinal condition called Crohn's disease, watched the Emmi program before she had a recent colonoscopy.

Miller has had previous colon exams and wasn't nervous about the procedure. But for the inexperienced, she believes it would take away "the intimidation factor."

Knowing more about the procedure may make it seem less unpleasant, and better informed patients are more prepared for their treatment, said Dr. Stephen Hanauer, the hospital's gastroenterology chief.

Research has shown that better informing patients about their care also can make them less likely to sue if something goes wrong. Still, it's no guarantee, and computer-based informed consent programs provide an electronic record that gives hospitals extra ammunition against malpractice lawsuits.

When patients watch Emmi programs, stopping and starting them to review information, they create an electronic trail. Hospitals have used that data in court to argue that patients were informed about specific risks because they watched portions of the program where risks were detailed.

Sara Juster, a vice president at Nebraska Methodist Health System, says that feature may have played a role in a patient's recent decision to drop a lawsuit against Methodist Hospital in Omaha.

The patient had sued over a shoulder injury her baby suffered during childbirth, a problem her first child also had encountered. The woman had watched an Emmi program detailing risks for the injury, but claimed she had not been informed, Juster said.

The hospital had electronic documentation, so the woman dropped her suit.

Juster said most of the system's obstetricians give pregnant patients "prescriptions" to watch Emmi programs about labor and delivery. Within the past eight years, obstetrics-related suits against the system's hospitals have dropped by half, from about 12 a year to six.

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Online:

Emmi Solutions: http://www.emmisolutions.com

Dialog Medical: http://www.dialogmedical.com

Foundation for Informed Medical Decision Making: http://www.informedmedicaldecisions.org/

Any questions, please drop me a line.

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