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Caring For Patients Who Refuse Blood Transfusion: Challenge or Dilemma?

Caring For Patients Who Refuse Blood Transfusion: Challenge or Dilemma?. Kathleen Yhlen RN MSN Clinical Educator Coordinator Bloodless Care Program Cooper University Hospital. Why do people object to receiving blood transfusions?. Personal concern Religious beliefs.

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Caring For Patients Who Refuse Blood Transfusion: Challenge or Dilemma?

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  1. Caring For Patients Who Refuse Blood Transfusion:Challenge or Dilemma? Kathleen Yhlen RN MSN Clinical Educator Coordinator Bloodless Care Program Cooper University Hospital

  2. Why do people object to receiving blood transfusions? • Personal concern • Religious beliefs

  3. Religious Beliefs • Jehovah’s Witnesses • Leviticus 17:13, 14, “You shall not partake of the blood of any flesh, for the life of all flesh is its blood. Anyone who partakes of it shall be cut off.” • Excommunication and eternal damnation

  4. Caring for Jehovah’s Witnesses • A problem? • A challenge? • Is their belief right or wrong? • Self-determination and Autonomy, including the right to die • Upheld in court

  5. CARING FOR THE JEHOVAH’S WITNESS PATIENT WHY? Cultural Competence • Professional Practice Acts • JCAHO • CMS Code of Ethics • Mission and Vision Statements

  6. CARING FOR THE JEHOVAH’S WITNESS PATIENT Culturally Competent Care • Practitioners sense of awareness • Own attitudes • Biases • prejudices

  7. WHAT IS BLOODLESS CARE ? A strategy of providing patient care by conserving blood and minimizing or eliminating the use of blood transfusions

  8. BLOOD CONSERVATION STATEGIES • Interview patient • ask about religious beliefs • objection to transfusions • advance directive • Comprehensive physical assessment

  9. BLOOD CONSERVATION STATEGIES • Anticipate and Plan • communicate with health care team • consider these pts. high risk • blood directive • consult hematologist • don’t “wait and see”

  10. BLOOD CONSERVATION STATEGIES • Conservation/Minimize blood loss • perform essential lab studies only • use pediatric/micro tubes • return flush from arterial lines

  11. BLOOD CONSERVATION STATEGIES Medical Management • Sign blood directive • Limit phlebotomy • Use pediatric or micro tubes • Correct anemia (iron, folic acid, B12,) • Epoetin Alpha (Procrit) this contains human albumin!!!

  12. Strategies • Patient identification • Computer/chart/wristband/labels • Pharmacy • Blood Directives/Consent forms • Advanced Directives • Nurse Coordinator • Physician support • Pastoral Care

  13. The Patient’s Role • Seek treatment early • Prepare an Advanced Directive • Prepare end-of-life decisions including assigning next of kin to children • Talk to family, friends and doctor • Find a doctor who will comply with your wishes • Discuss and sign Blood Directive/Consent

  14. The Patient’s Role • All competent patients have the right to refuse treatment/care • Understand diagnosis, options, alternatives • Decision must be voluntary, and informed

  15. BLOOD DIRECTIVE/CONSENT • Refusal of all and/or some blood and blood products • Doctor will discuss the risk and benefits of blood transfusion and alternatives • Major blood fractions • Minor blood fractions

  16. Refuses major blood products whole blood red cells White cells platelets plasma May accept minor blood fractions albumin clotting factors immune globulins cryoprecipitate antihemophilic factor other _____?________ Blood Directive

  17. Challenges • Do not be judgmental • Encourage and facilitate advanced planning • Be alert for opportunities for sensitive conversation • Hospitalization not ideal time to fill out advanced directive • Consult Bloodless Coordinator • Use Blood Directive or consent form

  18. Physician Rights • Have to be willing to let patient die • Refuse to provide care • Alternate physician agrees to take the case/transfer

  19. EPIC Order Set • “Bloodless Care” • Please have Patient Sign Blood Directive (Form #C692400)- Web links: Blood Directive English, Blood Directive Spanish • Limit Phlebotomy • Draw all labs with lowest volume tubes

  20. Case Studies • Mercy Hospital versus Jackson • J.W. presented at 26 weeks in preterm labor • Vaginal delivery contraindicated • C-section with 50% chance of needing a transfusion • Refused transfusion any circumstance • Court ruled competent to refuse

  21. Case Studies • Wons versus Public Health Trust of Dade County • 38 year-old female mother of two children 12 and 14 years old • Dysfunctional uterine bleeding • Symptomatic anemia required transfusion • Protection of innocent 3rd party?

  22. Case Studies • Shorter versus Drury • J.W refused transfusion prior to procedure • Wrongful death suit filed • Patient hemorrhaged during a D&C when uterus was perforated • No transfusion was administered

  23. QUESTIONS

  24. THANK YOU! Kathleen Yhlen, RN, MSN, NE-BC Nurse Coordinator Bloodless Care Program Cooper University Hospital office 342-2476 pager (856)962- 3763

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