The CMS guidelines require either a physician/CNP/PA documentation of the 
patient's refusal or a consent for blood draw form marked as refused by the 
patient and witnessed by a staff member. We have no "Consent for blood draw" 
form as this is included in the Condition of Admission so no means of meeting 
this option. Our policy is for the phlebotomist to document the patient's 
refusal in the lab results form and this is trackable electronically as to who 
entered the data. We have a couple of failures due to this patient refusal, 
usually at 3 of 4 a.m. when they are awakened for yet another blood draw just 
short of the 5 a.m. blood draw which is outside the 6 hour window.
I have submitted this situation to QualityNet and they do not seem inclined to 
accept this as a witnessed refusal. We do not have a process in place to have 
the physician document this patient refusal. Any suggestions?

Bruce Bainbridge, RN, BA | Clinical Data Analyst | Tri-City Medical Center | 
Quality & Performance Improvement | 4002 Vista Way | Oceanside, CA 92056
760-940-3789 I [email protected]<mailto:[email protected]> 
|www.tricitymed.org<http://www.tricitymed.org/>

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