Coordinators, Program Managers,

At your institution. If a patient is a JW who is responsible for placing the Identifying "No Blood" bracelet on the patients wrist? Would it be the Nurse on the floor or the admitting representative who 1st identified the patient by religous preference as "No Blood"?

Is placing a no blood bracelet on a patient by an admitting representative making a clinical decision that only nursing can make?

I'm new as a coordinator and my manager who worked on the policies is no longer with my hospital so any assistance you can give me would gladly be appreciated.

Richard Casas
AMMC

If the patient comes through the ER, self identifies as a JW, and has a "no blood" card or advanced directive, then the ER registration staff place an armband on the patient. If a question is raised about the pt's status, then the House Nursing Supervisor may get involved and place an armband (especially if there is no advanced directive). The Supervisor speaks with the patient, obtains a signed "Refusal of Transfusion" form and places the identifiers. A message is left with the Blood Mgt Coordinator for follow through when they are available.

Elective PreOp patients who are identified as being unwilling to accept blood transfusions (this is done on our scheduling form from the MD office) are contacted in advance by the Blood Mgt Coordinator who verifies their information, assists with surgical planning, monitors preop bloodwork, etc. Pt. identification bands, signs, stickers, etc. are provided to the PreOp area (along with BMC notes, etc.) in advance and the preop staff place the armband when the patient arrives at the facility for the procedure. If the pt has not provided a copy of their "no blood AD" in advance, they are asked to sign a "Refusal of Transfusion" form in the preop area.

All other inpatients / observation patients are identified through the nursing assessment (done within a minimum number of hours) upon admission. In our electronic record, this "triggers" a pop-up identifying the need to contact either the Nursing House Supervisor (if the issue is urgent or the pt. is actively bleeding) or to leave a voice mail for the BMC to followup when next available. This "trigger" also goes to a BMC daily "list" that is generated by the computer when either a "no" answer is provided to the question or the pt's religious preference indicates JW.

While we do not expect the registration personnel to label the pts with the "no blood" band, we do expect them to ask questions about "advanced directives" and obtain copies if they are available. Registration also scans these "advanced directives" into the permanent electronic record so they are easily retrievable upon subsequent admissions.

The problem with non-clinical folks "banding" the patient (from my perspective) is that there needs to be more discussion of a clinical nature to determine pt's rationale for their decision, provide education, discuss alternatives acceptable to the patient (such as personal conscience issues), etc. before identifying a "no blood" patient in our facility so insure that a patient truly has an "informed" decision, either pro or con to blood transfusions. Because we will honor the patient's decision and try to avoid "pressuring" tactics from our physicians and other clinical staff, we want to insure that the initial decision was truly "informed" and backed up by paperwork.

At the hospital were I work as the Coordinator, patients, when going through the registration process, are all given a brief questionaire that introduces them to the Bloodless Medicine program, and asks,"If the need should arise during your hospitalization for the need of a blood transfusion...I would or I would not accept." The patient marks their choice. If they come through the ER department, the NO BLOOD bracelet is put on by the registration personnel. If they are a direct admit, then the bracelet is suppose to be put on by the nurse who does their admisson, but unfortunately, this does not always happen. I get a report several times per day showing all patients in-house who are registered as Bloodless, so I can follow-up in a timely manner. I make sure the patient understands what it means to be bloodless. Some patients who are intially "tagged" as being bloodless, turn out to be OK with receiving a transfusion if it's a life or death situation, so in those situations, the NO BLOOD bracelet is removed, and these individuals are put on blood conservation...got a bracelet for that too.

Currently at my institution patients are given a no blood bracelet simply because they identify their religious preference as JW. This is done by the registration staff. Some patients complain because they were here for an Xray or other non invasive procedures while others are impressed by the proactive approach to respect the patients wishes. I do agree that more discussion has to take place for an informed decision to be documented. I have experienced situations when a patient changes from No Blood to Blood Conservation as Leslie noted and this is due to the patient not being a dedicated member of the JW faith or was aquainted at some point.

At your hospital do patients get identified with "No Blood" bracelets who come for diagnostic procedures such as Xray, MRI, Ultrasound, Mammo Screening etc.. Or would you say this is going too far in the indentification process?

Patients coming in for outpatient testing are not given a bracelet. And as you mentioned some patients get upset about even being asked to complete the questionaire..."I'm just having an x-ray", but then others appreciate knowing about the program. I've learned that you can't make everyone happy. I also send a follow-up letter to those individulas who came in for outpatient testing and have indicated interest in being a Bloodless Medicine patient. While the letters are simular in format, I have one that I send to those who indicate their religion as JW, and another version to everyone else. This has been a good way to market the program to our patient population. It's amazing how many people in the general population are unaware of the options available. These letters have resulted in a number of phone calls from individuals who wanted to learn more.

Does anyone in their Blood Management, Blood Conservation, Bloodless program have color bracelets and color dots to identify 'NO Blood' patients? Likewise to identify provisional patients?

My understanding is hospitals are moving towards national colors.

I.E.. Green (DNR), RED (Drug Allergies), Latex Allergy (Lavender), Falls Precaution (Yellow)

I visited a nearby hospital and they have the colored dot to represent the "No Blood" patient. Incidentally they do not have a Blood Management/Bloodless program.

What are the pros and cons? In your expertise.

Hello Everyone.

Does anyone have any feedback on this thread? If any of you are one of jehovah's witnesses and are reading this thread, how would you prefer to be identified when facing surgery or being hospitalized? A colored bracelet of which color would indicate no blood or would you prefer your bracelet to say "NO BLOOD".