If a procedure has been shifted from the physician to the nurse, can informed consent then be obtained by the nurse, or does that responsibility remain with the ordering physician? One facility, by using nurses for the insertion of peripherally inserted central catheters (PICC lines), challenged the previous way of thinking in order to enable their specialized nurses to obtain informed consent.
At St. Mary's Health Center in Jefferson City, MO, PICC lines were inserted by a small team of specially trained nurses. These nurses, who completed a special training program to become credentialed to insert the lines, were also allowed to obtain informed consent and explain to the patient what the procedure involved. This program had faded into the background for a number of years but recently returned to the forefront with the arrival of new leadership. The new leaders saw the benefits of PICC line usage and decided to aggressively pursue a full-strength re-implementation of the program.
“We had a process in place and were in the middle of bringing the program back into place,” says Lisa Randazzo, director of performance management and clinical outcomes at St. Mary's Health Center. “The question of informed consent came back up. We were getting a lot of different feedback from people doing it different ways.”
Because it had been some time since the PICC line program had been in place, the team reexamined the whole program from top to bottom. The issue of informed consent arose early on.
“We were told that informed consent is a doctor's responsibility, but we still had our nurses who had been a part of the program previously who thought [obtaining informed consent] had worked before,” says Randazzo.
So the facility began the research process.