“We found the language vague to a certain degree,” says Randazzo. “There is language that says to look at the person performing the procedure. Well, in this case, the nurse is performing the procedure.”
Randazzo went so far as to call the Standards Interpretation Group (SIG) of The Joint Commission for advice. She was pleasantly surprised when she received a callback from a representative of the SIG. “Usually you can expect a yes-or-no answer or an explanation of the standards,” says Randazzo. “A personal call was very surprising. I asked if I startled them with my question!”
What she was told, though, was that the language of the standards lagged a bit behind current technological trends and practices.
“He advised me to look at some of the national bodies covering PICC lines, like the state board of nursing,” says Randazzo. “We're in Missouri, so I also looked at the nurse practice act.”
Missouri's nurse practice act has a decision tree that is used by the state board to walk through the steps of a process and determine what a nurse can or cannot do.
“From looking at it, I found that if I entered the decision tree thinking the nurse could obtain informed consent, I would come to that conclusion at the end of the tree, or vice versa,” says Randazzo.
So she went back to the standards again to look for anything stating that a nurse could not obtain informed consent. She came up empty.
Randazzo also consulted national societies governing infusion clinics and organizations focusing on chemotherapy and blood transfusions.
“I found a little bit about PICC lines but not a lot about informed consent,” she says.