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What Should We Do?: Permission on ankle draws

Permission on ankle draws

by Dennis Ernst • March 07, 2019

Safety, Technical

Dear Center for Phlebotomy Education:

When drawing from a lower extremity I understand that we must have the physician's permission. But if the patient has multiple physicians, which one provides permission? How long is the standing order good for? Must it be in writing? Where/how do we document permission and what must the documentation include? I'm sorry for all the questions, but I'm having trouble converting the CLSI standards into policy. What should we do? 

My Response:

Don't apologize. I give questions from my subscribers a high priority.

When patients have multiple physicians, it's really up to the facility as to which one to obtain permission from. We recommend going to the patients primary care provider first. If the ordering physician is not the patient's primary physician, but has no qualms about providing permission, you should accept it. Any physician who doesn't feel he/she is the appropriate clinician, or who doesn't want to be held responsible for any complications, probably won't give permission, and will defer to another treating physician. 

Just make sure the permission is in writing, as required by the standards. The form in which written permission is granted is up to your facility. Whether it's in writing or electronically conveyed, just make sure it's retrievable for future draws and in case any questions, challenges, or complications arise. Unless stated otherwise, you can assume it's indefinite. But it would be a good practice to reaffirm permissions on a regular basis. Should the patient develop diabetes, feet/ankle draws should no longer be performed. Unless the physician reviews the permission regularly, draws to the lower extremities could lead to complications that were not a risk when permission was originally established.

   Lastly, the standards don't specify what should be included in the permission, but we recommend it identifies the patient, the physician and the date of permission at a minimum. 

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