Question for nurses.

[Yulia_R]

Just curious, is there ANY other medical procedure/surgery that can be preformed before the concent form is signed by the parents? I have heard more than once about the concent form being signed after circ is done (many times parents do agree to it verbaly, but the actual form was not signed until after it was done). And now I read about mistakenly circ'd baby and someone else says in the thread that the same thing happen to someone they know. So I was just wondering 1. how typical it is to sign circ concent form after then fact and 2. is there any other procedure (including newborn vaccination) that can be done before the concent form is signed (I think it is a good info to know...just in case).

thanks in advance!

[2lilsweetfoxes]

Not a nurse, myself, but personally, I think the only procedures that should be performed without a signed consent form is if taking 5 minutes to go over the consent form, the procedure, risks and benefits of the procedure, and what, if any, alternatives there are and the risks and benefits of those (to include not doing anything or waiting) means the difference between the baby living or dying or being severely compromised.

[Fyrestorm]

Many, Many newborn procedures are preformed based on the blanket consent that you sign when you arrive at the hospital.

[katelove]

In Australia there is no such thing as blanket consent. All surgical procedures must have an individual consent form. The procedure must be explained, including risks, to the patient (or parent) by the person who will be performing the surgery and both surgeon and patient/parent sign the consent form at that point. The surgeon must hand write on the consent form what procedure is consented for before they both sign.

It is acceptable for the surgeon to write variants in ie "laparoscopic cholecystectomy proceeding to open cholecystectomy if necessary" but again, this all has to be explained to the patient by the surgeon.

There is also a clause about performing "whatever lifesaving procedures which are deemed necessary by the surgeon should the need arise" or words to that effect. Again though, this is all explained and the patient can opt out if, for example, they don't want to be given blood products.

In the case of a circ the doctor performing the circ would do the above with the parents. The nurse assisting would check the consent with the parents before taking the baby to the room where it was being done. It helps that public hospitals don't usually do them. The parents have to find a private paed or surgeon and they aren't usually done while newborns are in hospital due to infection risks. So, typically, the parents will be taking the baby to a hospital/Dr's surgery specifically to have the circ done.

ETA - blanket consent does not meet the requirements of "informed consent" under Australian law.

[Yulia_R]

Originally Posted by 2lilsweetfoxes

Not a nurse, myself, but personally, I think the only procedures that should be performed without a signed consent form is if taking 5 minutes to go over the consent form, the procedure, risks and benefits of the procedure, and what, if any, alternatives there are and the risks and benefits of those (to include not doing anything or waiting) means the difference between the baby living or dying or being severely compromised.

Yes, of course. I guess I should clarify that I was talking about a healthy newborn (therefore, ellective procedures).

[Yulia_R]

Originally Posted by Fyrestorm

Many, Many newborn procedures are preformed based on the blanket consent that you sign when you arrive at the hospital.

Are you talking about NICU? I mean a healthy newborn baby.

[Yulia_R]

Originally Posted by katelove

In Australia there is no such thing as blanket consent. All surgical procedures must have an individual consent form. The procedure must be explained, including risks, to the patient (or parent) by the person who will be performing the surgery and both surgeon and patient/parent sign the consent form at that point. The surgeon must hand write on the consent form what procedure is consented for before they both sign.

It is acceptable for the surgeon to write variants in ie "laparoscopic cholecystectomy proceeding to open cholecystectomy if necessary" but again, this all has to be explained to the patient by the surgeon.

There is also a clause about performing "whatever lifesaving procedures which are deemed necessary by the surgeon should the need arise" or words to that effect. Again though, this is all explained and the patient can opt out if, for example, they don't want to be given blood products.

In the case of a circ the doctor performing the circ would do the above with the parents. The nurse assisting would check the consent with the parents before taking the baby to the room where it was being done. It helps that public hospitals don't usually do them. The parents have to find a private paed or surgeon and they aren't usually done while newborns are in hospital due to infection risks. So, typically, the parents will be taking the baby to a hospital/Dr's surgery specifically to have the circ done.

ETA - blanket consent does not meet the requirements of "informed consent" under Australian law.

Nice! Too bad we aren't in Australia...

[Fyrestorm]

Originally Posted by Yulia_R

Are you talking about NICU? I mean a healthy newborn baby.

Healthy Newborns...they automatically do Heb B, Vit.K, Bathe, Suction etc. All without an additional consent. They used to do circs without an additional consent as well. It was considered a newborn procedure for boys and covered under the blanket form.

They tried to give DD a VCUG without consent using the blanket form. Fortunately, I wrote explicitly what I did and did not consent to all over the forms. "No Vit. K" "No eye Profolactics" "No Heb B" "No invasive procedures without notification and consent" etc.

Part of the reason that I won my suit was because they did the cath for the VCUG without my additional consent and didn't get the court order to cover the cath. (they also forgot that they needed an additional consent on top of the blanket for the radioactive dye).

[Yulia_R]

Originally Posted by Fyrestorm

Part of the reason that I won my suit was because they did the cath for the VCUG without my additional consent and didn't get the court order to cover the cath. (they also forgot that they needed an additional consent on top of the blanket for the radioactive dye).

Oh my...I'm so sorry, mama (HUGS)

[Yulia_R]

Originally Posted by Fyrestorm

Healthy Newborns...they automatically do Heb B, Vit.K, Bathe, Suction etc. All without an additional consent.

I think not any more. When both of my kids were born (2005 and 2006) they did ask me to sign whether a concent form for Hep B and vit K or a form stating that I did not want those done. Both times I declined Hep B, but unfortunately for my son, he did get the vit K shot . As far as bathing and suction, you are right, it is still done routinely without a concent form. With my son we requested to bath him overselves (with a help of a nurse) later in our room and our daughter ended up going home unbathed

[MommytoB]

I think in the California place where I was things were covered under the blanket consent form .

I don't think I ended up getting asked about Vit K, eye drops or Heb B.

I do know that the Hep B is in his chart of Vaxes .

I did get asked if I wanted to have his hearing checked .

[Yulia_R]

Originally Posted by MommytoB

I think in the California place where I was things were covered under the blanket consent form .

I don't think I ended up getting asked about Vit K, eye drops or Heb B.

I do know that the Hep B is in his chart of Vaxes .

I did get asked if I wanted to have his hearing checked .

Interesting. I guess it depends on a state or maybe even on every individual hospital. I had both of my kids in AZ (two different hospitals).

[nia82]

In CA they had me sign indivudal consent forms for eye ointment and vitamin K, which we both declined. The HepB wasn't done by nurses, but the ped on call, so we put up that fight with her. I would think though that if any of that happened before I was presented with a form, the hospital would be covered by the blanket consent form upon admission.

[kate3]

I'm in the Boston area, and there is no "blanket consent". At the hospital I worked at (and others in the area), circs are an elective surgical procedure, and therefore require a consent, MD consult, a "time out" called prior to the procedure, and scheduling with the nursery staff. No baby is "taken away" for a circ without all of the above.

Hep B also requires parental consent, as well as expanded newborn screening. Parents are also asked about hearing screens and can refuse or delay if the timing is inconvenient (ie baby is nursing).

Vit K and erythromycin eye ointment are considered routine care and do not have a specific consent. Parents are free to refuse if they want to.

I cannot speak to other states or countries as I have only worked in Massachusetts. Hope this helps!

[AAK]

I was doula for a mom (WA state) and her baby was large. They required three blood draws to check sugar levels. Mother tried to refuse and was told that this particular test was one where they could call CPS in to remove child for tests. It was done with a small heel prick, so after we discussed it, mom consented to the test. She later filled out an AMA form and left within hours. No more tests for her. I think the cutoff was baby larger than 9 lb 2 oz. But I heard that it was changed to 9 lbs even. Not sure though. Also, the eye goop was required simply by entering the hospital and the vit k as well. She was able to decline hep b.

Amy

[Yulia_R]

Originally Posted by kate3

I'm in the Boston area, and there is no "blanket consent". At the hospital I worked at (and others in the area), circs are an elective surgical procedure, and therefore require a consent, MD consult, a "time out" called prior to the procedure, and scheduling with the nursery staff. No baby is "taken away" for a circ without all of the above.

Sorry if it's a lame question, but what's "time out" (before the circ procedure)?

[Yulia_R]

Originally Posted by AAK

I was doula for a mom (WA state) and her baby was large. They required three blood draws to check sugar levels. Mother tried to refuse and was told that this particular test was one where they could call CPS in to remove child for tests. It was done with a small heel prick, so after we discussed it, mom consented to the test. She later filled out an AMA form and left within hours. No more tests for her. I think the cutoff was baby larger than 9 lb 2 oz. But I heard that it was changed to 9 lbs even. Not sure though. Also, the eye goop was required simply by entering the hospital and the vit k as well. She was able to decline hep b.

Amy

WOW! I've never heard about a hospital that would not allow parents to decline vit K and eye goop...and all those endless heel prick tests...crazy. By the way, just curious, did the insurance company cover the labor/stay after she left AMA? I wanted to leave the hospital AMA with my daughter, but was told that if I do so the insurance wouldn't cover anything (including my c-section) . I though wonder if it was just another BS...

[brant31]

Originally Posted by Yulia_R

Sorry if it's a lame question, but what's "time out" (before the circ procedure)?

It's kind of like a football huddle, but where everyone double-checks everyone else. Here is a description from a friend's email. She is an MD:


Before any surgical procedure, we have what is called "Time Out."

Time out consists of EVERYONE, anesthesiologist, scrub nurse, circulating nurse, & surgeon looking at the patient name tag, the name on the chart, the signed consent form-patient name & the signature, the H&P, specific equipment details (for surgery), ALL matching the print out from my office.

Before going into surgery, the surgeon must initial the surgical site. Occasionally for midline -- non-right-or-left procedures -- the hospital can (must have) a written exception to the surgical site-marking rules.

This must be done & documented prior to any procedure.

If I were the family in Miami, I would file a complaint with both JACHO & the state licensing board on each individual in the circumcising room, and against the individuals who sent the infant to the circumcising room, the ones who typed the surgical schedule (if they have one) & the ones who "pulled" the sterile surgical instruments.

This battery falls into the category of a NEVER occurrence. This is a MOST serious licensing & disciplinary issue.

Discovery items to request:
Hospital's written time out rules, the hospital's written consent rules, the hospital's written medical necessity rules. Hospital will try to say that such written rules are only for the OR, not the circumcision room. Get the OR rules anyway & make them part of the depos. Get those rules in front of the jury. The rules concern the ACT of surgery, not PLACE of surgery.

Concerning the fact that the hospital informed the family- It is the LAW that people be informed of hospital "mistakes."


So, there you have it from a doctor in "middle America".

[Yulia_R]

Originally Posted by brant31

It's kind of like a football huddle, but where everyone double-checks everyone else. Here is a description from a friend's email. She is an MD:


Before any surgical procedure, we have what is called "Time Out."

Time out consists of EVERYONE, anesthesiologist, scrub nurse, circulating nurse, & surgeon looking at the patient name tag, the name on the chart, the signed consent form-patient name & the signature, the H&P, specific equipment details (for surgery), ALL matching the print out from my office.

Before going into surgery, the surgeon must initial the surgical site. Occasionally for midline -- non-right-or-left procedures -- the hospital can (must have) a written exception to the surgical site-marking rules.

This must be done & documented prior to any procedure.

If I were the family in Miami, I would file a complaint with both JACHO & the state licensing board on each individual in the circumcising room, and against the individuals who sent the infant to the circumcising room, the ones who typed the surgical schedule (if they have one) & the ones who "pulled" the sterile surgical instruments.

This battery falls into the category of a NEVER occurrence. This is a MOST serious licensing & disciplinary issue.

Discovery items to request:
Hospital's written time out rules, the hospital's written consent rules, the hospital's written medical necessity rules. Hospital will try to say that such written rules are only for the OR, not the circumcision room. Get the OR rules anyway & make them part of the depos. Get those rules in front of the jury. The rules concern the ACT of surgery, not PLACE of surgery.

Concerning the fact that the hospital informed the family- It is the LAW that people be informed of hospital "mistakes."


So, there you have it from a doctor in "middle America".

Very interesting! Thanks!! I had no idea...

[AAK]

Originally Posted by Yulia_R

WOW! I've never heard about a hospital that would not allow parents to decline vit K and eye goop...and all those endless heel prick tests...crazy. By the way, just curious, did the insurance company cover the labor/stay after she left AMA? I wanted to leave the hospital AMA with my daughter, but was told that if I do so the insurance wouldn't cover anything (including my c-section) . I though wonder if it was just another BS...

I am pretty sure it was still covered. If not, she never mentioned it to me and the hospital didn't use it as a reason to try to keep her.

Amy