Just in time teaching New Consent Surgery and Procedure Consent Forms New consent forms go live 12/2/13 Here’s what you need to know. The consent forms have been updated to make them more readable for families (6th grade reading level) and to comply with The Joint Commission (TJC) and the Centers for Medicare and Medicaid Services (CMS) regulatory agencies. There are now 2 forms for surgery and procedures used in the organization: 1. Surgery/Procedure Consent with Anesthesia and Blood Consent. Used with surgery patients in Day Surgery, Surgicenter, in-patient units and EDTC. Also used with some Interventional Radiology patients if anesthesia is involved. 2. Procedure Consent without Anesthesia Services Used outside of Day Surgery and Surgicenter for Procedures or Treatments. Used when a parent signature for an informed consent discussion as long as anesthesia is not involved. 

NEW: Blood consent has been added to the surgical/procedure consent. This is a trend across the country. It is good for patient’s entire hospital stay. Rationale: o Consent is for those needing blood. It limits the number of consents to be signed. o For those who do not expect to have blood, the discussion with the provider should take place and permission should be granted. o Use the usual blood consent form for all blood administration not involving surgery.

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NEW: The surgical/procedure consent with anesthesia may have been signed in the surgeon’s office. It can be found under the media tab listed as a scanned document:consent. Access staff will look in this area before printing the consent in the surgical areas so that parents are not signing a 2nd consent.

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NEW: The provider signature is no longer a part of the consent forms. Regulatory bodies do not require it on the form.

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NEW: Use teach-back when asking parents about surgeries or procedures they are having to check for understanding. This is a national safety practice.

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A Refusal for Blood or Blood Products form will be used if families of minors do not want to consent for blood or blood products. Nurses will contact the provider if the family is refusing blood to alert them of this information.

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If the patient is a competent adult they may refuse blood without signing the form. Contact the provider if the patient is refusing blood.

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Crossing things off the consents is not allowed. Contact Risk Management if there are concerns identified by the family. There is someone on call 24/7.

Your resources: Surgical Services: Paula Schmidt, Anita Norton, Denise Augustin, Kim Somers, Kathy Leack, Suzan Buchaklian Surgicenter: Karen Dziadowicz Risk Management: Janet Dixon Imaging: Linda Flannery Provider: Debbie Dolata-Drent Education: Carol Klingbeil Consent for Treatment P & P Refusal to Consent for Treatment and Blood Products © 2013 Children’s Hospital and Health System. Date to review: 2016

* Date 11/2013

Contact: Risk Management