Blue 783 Clinical Management of Jehovahs Witnesses and Other Patients Who Refuse Blood Components

Document name: Jehovah’s Witnesses and other Patients who refuse Blood Components Ref.:783 Issue date: 3 April 2013 Status: Approved Author: Helen Maria Page 1 of 21

Jehovah’s Witnesses and other Patients who refuse Blood

Components Policy for the Clinical Management

Reference Number: 783

Author & Title: Helen Maria, Transfusion Specialist

Responsible Director: Medical Director

Review Date: 3 April 2016

Ratified by: Tim Craft Medical Director

Date Ratified: 3 April 2013

Version: 3

Related Procedural Documents Blood Component Transfusion Policy

Consent to Examination & Treatment Policy Safeguarding Children (Child Protection Policy)


Index: Introduction ______________________________________________________ 3

Purpose of this policy ______________________________________________ 3

Aims and objectives of this policy ____________________________________ 4

1. Establishing the patient’s beliefs and wishes _______________________ 4

2. Management of adults over the age of 18 __________________________ 4

3. Jehovah’s Witnesses position on medical treatment and related matters 5

3.1. Acceptable medical treatment ______________________________________ 5

3.2. Personal choice __________________________________________________ 5

3.3. Usually unacceptable medical treatments _____________________________ 6

3.4. Advance Directives and patient identification __________________________ 6

4. Children of Jehovah’s Witnesses under the age of 18 ________________ 7

4.1. Management _____________________________________________________ 7

4.2. Strategy _________________________________________________________ 7

4.3. Liaison with Jehovah’s Witnesses Hospital Liaison Committee ___________ 8

4.4. Court referral ____________________________________________________ 8

5. Treatment of obstetric haemorrhage in women over the age of 18 who refuse a blood transfusion __________________________________________ 9

5.1. Advance planning ________________________________________________ 9

5.2. Management of women refusing blood transfusion ____________________ 10

5.3. Labour _________________________________________________________ 11

5.4. Haemorrhage ___________________________________________________ 12

6. Treatment of haematological malignancies in patients over the age of 18 who refuse a blood transfusion _____________________________________ 13

7. Consent forms _______________________________________________ 14

8. Duties / Responsibilities _______________________________________ 14

9. Monitoring Compliance ________________________________________ 15

10. Review _____________________________________________________ 16

11. References __________________________________________________ 16

Appendix 1: Bristol Hospital Liaison Committee contact details _________ 18

Document Control Information ______________________________________ 19

Ratification Assurance Statement _____________________________________ 19

Consultation Schedule _______________________________________________ 20

Equality Impact: (A) Assessment Screening ____________________________ 21


Amendment History Issue Status Date Reason for Change Authorised 2 Approved May 2009 Review Clinical

Governance Committee

3 Approved 3 April 2013 Review Tim Craft Medical Director

Introduction People in the UK may refuse blood component transfusion for many reasons such as fear of errors, infection transmission or because of religious beliefs. This policy provides guidance for staff within the Royal United Hospital, Bath NHS Trust about the requirements and processes for the management of patients, including Jehovah’s Witnesses, who refuse blood components. This policy applies to all employees of the Royal United Hospital Bath NHS Trust.

Purpose of this policy The purpose of this policy is to:

• ensure that the beliefs and wishes of patients who refuse blood components during their episode of care are acknowledged and respected

• to provide information to clinicians about the management of these patients • to facilitate and expedite non-blood medical management for these patients


Aims and objectives of this policy

1. Establishing the patient’s beliefs and wishes • The extent of the patient’s personal beliefs and wishes must be established,

including their wishes in case of emergency and whether they fully understand the potential implications of their refusal of blood components (see 3.3.4).

Ensure this conversation and the outcome is fully documented within the medical notes. • The patient’s wishes must be verified at each admission as their attitude to blood

transfusion may have changed since the previous visit. • In an emergency and in the absence of a (written or verbal) refusal of treatment

or advance directive and where the patient is unable to communicate, treatment which is in the best interest of that individual will be given.

2. Management of adults over the age of 18 In elective and urgent cases, when blood transfusion may be likely or possible, it is essential that medical and nursing staff elicit the individual views of the patient. In the event of the patient refusing blood components, the following actions should be considered:

• Review non-blood medical alternatives and treat without using allogeneic blood. An important aspect of the management of the elective patient who refuses blood is ensuring Trust preoperative assessment guidelines are used with the aim of optimising haemoglobin prior to surgery.

• Consult with other doctors experienced in non-blood management and treat without using allogeneic blood.

• If necessary, consider transfer of the patient to another hospital where appropriate facilities are available before their condition deteriorates.

• Discuss with the Royal United Hospital Clinical Ethics Committee, which can be contacted at any time via the hospital switchboard. The coordinator for the Committee can be contacted on x1002.

• With permission of the Jehovah’s Witness patient, consult with the Bristol Hospital Liaison Committee of Jehovah’s Witnesses, which can be contacted at any time (Appendix 1)


In a life-threatening emergency, the above actions should be followed whenever possible. If this is not possible, the patient’s views, if known to the medical and nursing staff involved, must be honoured.

3. Jehovah’s Witnesses position on medical treatment and related matters

3.1. Acceptable medical treatment Jehovah’s Witnesses accept most medical treatments, surgical and anaesthetic procedures, devices and techniques, as well as haemostatic and therapeutic agents that do not contain blood. For example, they accept: • Non-blood fluids such as crystalloids (e.g. saline, Hartmann’s

and dextrose) and colloids (e.g. gelatin, hydroxyethylstarch) • Agents such as erythropoiesis stimulating agents (ESAs),

desmopressin, vasoconstrictors and recombinant clotting factors

3.2. Personal choice Each Witness will decide whether they wish to accept the following as a matter of personal choice. It is essential to discuss whether or not these procedures are acceptable with each patient:

• Intra-operative cell salvage (ICS), haemodialysis and haemodilution: to make such techniques acceptable, it is helpful if the diverted blood can be perceived as being in contact with the patient. An ICS Technical Factsheet Cell Salvage in Jehovah’s Witness patients is available on www.transfusionguidelines.org.uk

• Cryoprecipitate • ‘Fractions’ of plasma or cellular components (e.g. albumin,

immunoglobulins, clotting factors, vaccines, PCCs, Fibrinogen concentrate, haemoglobin-based oxygen carriers)

• Stem cell transplantation procedures, transplants and donations of solid organ, bone, tissue etc. not involving blood transfusion

• Blood patches and platelet gels which are generated and used intraoperatively and use the patient’s own blood or platelets

http://www.transfusionguidelines.org.uk/


3.3. Usually unacceptable medical treatments • Transfusions of whole blood, packed red cells, white cells,

platelets, and plasma • Preoperative autologous blood collection and storage for later

infusion • Elective termination of pregnancy

3.4. Advance Directives and patient identification Most Jehovah’s Witnesses will carry an Advance Directive in the format specified in the Mental Capacity Act, 2005 to communicate their refusal of whole blood, packed red cells, white cells, platelets and plasma and their individual choice regarding acceptance or refusal of autologous procedures and ‘fractions’ of plasma or cellular components. This document is entitled Advance Decision to Refuse Specified Medical Treatment. Refer also to the Trust Consent to Examination and Treatment Policy.

• Some Witness patients may wish to provide and wear their own ‘No Blood’ wristband. The NPSA (National Patient Safety Agency) Safer Practice Notice No.24 (3 July 2007) states: ‘Patients who wish to wear their own wristbands in hospital should be permitted to do so, but advised of the dangers of confusion for staff.’ Trust identification policy prohibits the application of more than one wristband. Staff are advised to discuss the purpose of the band with the patient and ensure it is completed correctly.

• Blood sampling must be kept to a minimum but careful

monitoring of the patient’s haematological status must not be neglected.


4. Children of Jehovah’s Witnesses under the age of 18

This policy endeavours to facilitate the choice of treatment that does not involve allogeneic blood and/or its primary components, i.e. red cells, white cells, plasma and platelets.

It recognises that some Witness parents find intra and post-operative cell salvage, haemodilution, haemodialysis and the use of ‘fractions’ of plasma or cellular components acceptable. It is therefore essential to establish the parents’ personal views on these procedures and treatments for their child.

It recognises that a blood transfusion may be essential to save the life of a child in an emergency or as part of major elective surgery.

For children up to the age of 18, even those who are ‘Gillick competent’, it would be normal practice for doctors to request transfusions in life-threatening situations and give them against parental wishes. Where time permits it would be normal to involve the Court. (See 4.4 below)

4.1. Management The following staged management plan will be adopted in caring for any child or neonate whose parents are Jehovah’s Witnesses:

4.2. Strategy The paediatric team will fully explore its options for utilising bloodless medicine and surgery in order to treat without allogeneic blood transfusion. This should include careful assessment of the benefits and risks of all management options, followed by a detailed discussion with the parents. If a procedure can be safely performed elsewhere without blood transfusion then it is the responsibility of the consultant to arrange referral. Transfer to another hospital should not take place if it is not in the child’s best interest to be moved.


4.3. Liaison with Jehovah’s Witnesses Hospital Liaison Committee In the event of anticipated difficulties with the proposed procedures, the Consultant or Trust may, with patient consent, contact the Bristol Hospital Liaison Committee for Jehovah’s Witnesses who may be able to provide further information about hospitals and doctors with experience of management of the condition without blood components. The Liaison Committee can also provide support and guidance for the parents (Contact details listed in Appendix 1).

4.4. Court referral There may be rare occasions where transfusion is considered necessary against the beliefs and wishes of the parents. The Trust’s legal advisors must be contacted via Switchboard in this situation. In the event that these nominated individuals are not available, contact the on-call Hospital Manager. If Court assistance is considered necessary, the patient (depending on maturity) and/or those with parental responsibility must be notified immediately of the intended action and invited to any case conference. It is normal procedure to refer the case to the Child Protection Team / Social Services (refer to Safeguarding Children Policy 221). The following steps must have been considered or acted on (time permitting): • All non-blood medical management options have been fully

explored • The risks of both using and not using blood have been fully

considered • Whether there is another hospital willing to treat without blood

and transfer would not risk the health of the child. • The case has been referred to the RUH Clinical Ethics

Committee • The Hospital Liaison Committee for Jehovah’s Witnesses has

been approached for assistance (Appendix 1)

In a life-threatening situation where transfusion is judged clinically essential, but against the parents’ wishes and beliefs, blood components should be administered. In this situation the hospital legal advisors must be notified after the event, via the on-call Hospital Manager. It is recommended that where possible this action be agreed by two consultants.


5. Treatment of obstetric haemorrhage in women over the age of 18 who refuse a blood transfusion

This section outlines a modified management approach for women refusing blood transfusion for whom significant obstetric haemorrhage is an emergency requiring immediate treatment. For female patients under the age of eighteen, see section 4.

5.1. Advance planning 5.1.1 If it is thought that a woman may refuse a blood transfusion in a

life-threatening circumstance, it is important that the management of a massive haemorrhage is considered in advance

5.1.2 All Jehovah’s Witness pregnant women must be referred to the

consultant antenatal clinic for discussion about management of pregnancy and delivery.

5.1.3 Support and assistance for Jehovah’s Witness patients can be

obtained from the Bristol Hospital Liaison Committee for Jehovah’s Witnesses (Appendix 1)

5.1.4 Further information may be obtained from:

Royal College of Surgeons Code of Practice for the Surgical Management of Jehovah’s Witnesses (RCS 2002 http://www.rcseng.ac.uk/publications/docs/jehovahs_witness.html

Care Plan for Women in Labour Refusing a Blood Transfusion http://www.transfusionguidelines.org.uk/docs/pdfs/bbt-04_care-plan-v2.pdf

Clinical Strategies for Avoiding & Controlling Haemorrhage and Anaemia without Blood Transfusion in Obstetrics & Gynaecology (2009, available from the JW Hospital Liaison Committee)

http://www.rcseng.ac.uk/publications/docs/jehovahs_witness.html

http://www.rcseng.ac.uk/publications/docs/jehovahs_witness.html

http://www.transfusionguidelines.org.uk/docs/pdfs/bbt-04_care-plan-v2.pdf

http://www.transfusionguidelines.org.uk/docs/pdfs/bbt-04_care-plan-v2.pdf


5.2. Management of women refusing blood transfusion

5.2.1 Booking: Initial notification

At the booking clinic women are asked about their religious beliefs and must be asked if they have any objection to a blood transfusion. If the woman is a Jehovah’s Witness or otherwise likely to refuse transfusion this should be recorded in the case notes and the patient asked to sign a consent form excluding blood transfusion. Every woman who chooses to refuse a blood transfusion must be given a copy of the Maternity Services Patient Information Leaflet Refusal of Blood Transfusion in Pregnancy. If the patient has completed an Advance Decision to Refuse Specified Medical Treatment this should be included in the case notes. Seek senior advice at all stages.

5.2.2 Patient choice Some Jehovah’s Witnesses will accept the use of ‘fractions’ of plasma or cellular components (e.g. prophylactic anti-D, albumin) or procedures such as intraoperative cell salvage. This should be discussed and the patient’s choice documented clearly in the maternity notes (hand held and hospital).

5.2.3 Risks

If the patient enquires about risks she must be given all information including the risks of transfusion and refusal. She must be advised that if massive haemorrhage occurs there is an increased risk that hysterectomy may be required.

5.2.4 Blood testing

Blood group and antibody status must be checked in the usual way and the haemoglobin (with serum ferritin, if appropriate) must be regularly checked. Oral iron supplementation must be given throughout pregnancy to maximise iron stores. If the haemoglobin remains low despite standard treatment, the case must be discussed with a haematologist. Following this, ESAs and/or intravenous iron may be considered.

5.2.5 Scan

An ultrasound scan must be carried out to identify the placental site.


5.2.6 Complications If any significant complications are noted during the antenatal period, the Consultant obstetrician must be informed.

5.3. Labour 5.3.1 The woman must be actively encouraged to deliver at the RUH,

not at home or in the community.

5.3.2 The on-call registrar and the on-call consultant obstetrician must be informed when a woman who has refused blood transfusion is in labour. The labour must be managed routinely by experienced staff. Oxytocics should be given as usual when the baby is delivered. The woman must be observed closely in the delivery suite during the postpartum period for at least one hour.

5.3.3 If a Caesarean section is necessary it should be discussed with the on-call consultant obstetrician and carried out by the most experienced surgeon available, with close attention to haemostasis.

5.3.4 An intravenous solution of oxytocin should be considered after the delivery of the baby if the patient has any of the following risk factors: previous history of bleeding or post or ante partum

haemorrhage prolonged labour increased maternal age (>40 years) and/or maternal

obesity multiple pregnancy and/or >4 children difficult operative delivery abnormal placentation/retained products >3.5 kg baby polyhydramnios fibroids

5.3.5 When the woman is discharged, she must be advised to report immediately if she has any concerns about bleeding during the puerperium.


5.4. Haemorrhage • The key to management of haemorrhage in these cases is to

AVOID DELAY and ensure senior assistance. Rapid decision making may be necessary, particularly with regard to surgical intervention.

• Refer to RUH Management of Massive Blood Loss guideline. • If unusual bleeding occurs at any time during pregnancy, labour or

the puerperium, the consultant obstetrician must be informed and standard management commenced promptly with a lower intervention threshold than in other cases. Any abnormal bleeding and complications such as clotting abnormalities must be dealt with as quickly as possible.

• The consultant anaesthetist and haematologist must be notified as soon as possible in the presence of abnormal heavy bleeding.

• Intravenous crystalloid and artificial colloids should be used. • In cases of severe bleeding, give intravenous Vitamin K • Consider antifibrinolytics such as tranexamic acid (1g IV over 10

minutes followed by 120mg/hr for 8 hours) • Consider desmopressin • Recombinant Factor VIIa (NovoSeven) provides site-specific

thrombin generation. Discuss use with Consultant Haematologist. • The woman and her family must be kept fully informed. If standard

treatment fails to control the bleeding, she must be advised that a blood transfusion is strongly recommended. Any patient is free to change her mind about a previously agreed plan. The doctor must be satisfied that the patient is not being subjected to pressure from others. Subject to patient consent, it is reasonable to ask any accompanying person to leave the room whilst a doctor (with a midwife or other colleague) can ask whether she is making the decision of her own free will. However, pressure should never be applied to prompt abandonment of deeply held beliefs.

• If the woman maintains her refusal to accept blood components, her wishes must be respected. The legal position is that any competent adult is entitled to refuse treatment, even if it is possible the refusal will result in her own death, or the death of or harm to the unborn child. No other person is legally able to consent treatment for that competent adult or to refuse treatment on that persons’ behalf.

• Massive obstetric haemorrhage usually occurs in the form of a postpartum haemorrhage. A hysterectomy is usually the last resort, but in women refusing blood transfusion, delay may increase the risk. The woman’s life may be saved by performing a hysterectomy before the haemoglobin has fallen to life-threatening levels. Its


timing is a decision for the consultant present. When it is performed, the uterine arteries should be clamped as early as possible in the procedure. A subtotal hysterectomy can be just as effective as and quicker than a total hysterectomy. Alternatively, a B-Lynch brace suture has been used to avoid hysterectomy.

• If the woman survives the acute episode and is transferred to the ITU, amongst the treatments to be considered are: mechanical ventilation high dose ESAs with parenteral iron supplementation (eg.

Cosmofer) with adequate protein intake for haemoglobin synthesis.

• Blood sampling must be kept to a minimum but careful monitoring of the patient’s haematological status must not be neglected.

6. Treatment of haematological malignancies in patients over the age of 18 who refuse a blood transfusion

6.1 It is increasingly possible to treat haematological malignancies without

primary blood component support. This will require a multidisciplinary team and the design of a patient specific care plan.

6.2 Blood sampling must be kept to a minimum but careful monitoring of the

patient’s haematological status must not be neglected. 6.3 Correction of anaemia should be commenced promptly with special

consideration being given to the use of ESAs and intravenous iron. 6.4 Consider the early use of novel therapies which may have a reduced

myelosuppressive effect. 6.5 For more detailed suggestions and supporting references see Developing a

Blood Conservation Care Plan for Jehovah’s Witnesses with Malignant Disease, presented at the BSH Annual Scientific Meeting, April 2007.


7. Consent forms 7.1 Jehovah’s Witnesses over the age of 18 who are having surgery and do not

wish to have blood or blood components must complete RUH Consent form 1 excluding blood transfusion

7.2 For under 18s, RUH Consent form 2 must be used

7.3 Refer to RUH Consent to Examination & Treatment Policy

8. Duties / Responsibilities 8.1. Chief Executive and Board of Directors bear overall responsibility for this

policy and shall carry this out by overview of significant risks via the Operational Governance Committee.

8.2. Divisional Directors will ensure that their managers and staff implement this

policy within clinical areas. 8.3. Clinical Directors and Heads of Service will oversee the application of this

policy into the clinical practices of their services. 8.4. Consultant Medical staff are responsible for ensuring this policy is applied

and followed. The consultant of the patient needs to be aware that the patient is refusing blood components as early as possible in the plan of care. They should be confident in their ability to treat the patients under these circumstances or refer them immediately to a Clinician/ Anaesthetist who has specialist knowledge of this area.

8.5. Complaints & Litigation Manager is responsible for the provision of legal

advice during normal working hours and ensuring effective arrangements are in place to enable legal advice out of normal working hours via the On-Call Hospital Manager.

8.6. Hospital Transfusion Team

Consultant Haematologist, Blood Bank Manager, Transfusion Practitioner (TP) are responsible for providing information and support for the clinical team involved with patients refusing blood or blood components.

8.7. On Call Duty Consultant Haematologist

The On Call Duty Haematologists provides a 24 hour advisory service and can be contacted via the hospital switchboard.


8.8. Anaesthetist If the patient is coming for elective surgery the anaesthetist must

be made aware as soon as possible. This will allow for adequate planning and discussion with the patient and relevant teams.

8.9. Preoperative assessment (POAS) POAS review all pre op patients and will identify patients that refuse blood components as part of treatment for further assessment and management.

8.10. Patient refusing blood and blood components 8.11. Jehovah’s Witness patients should carry with them documentation known as

“Advanced Decision to Refuse Specified Medical Treatment”

8.12. Hospital Liaison Committee for Jehovah’s Witnesses 24 hour contact (with patients permission) for support in assisting to manage Jehovah’s Witnesses (Appendix 1).

9. Monitoring Compliance

Document Audit and Monitoring Table Monitoring requirements: Referred cases sent to the Hospital Transfusion

team will be evaluated and measured against policy to ensure correct decision making process were applied, to optimise care and to implement changes to future care appropriately. Transfusion team meets once a month.

Monitoring Method: Quarterly review of referrals from hospital departments involved in treatment

Monitoring prepared by: Transfusion Team

Monitoring presented to: Hospital Transfusion Committee (HTC)

Frequency of presentation: Quarterly


10. Review This policy will be subject to a planned review every 3 years as part of the Trust’s Policy Review Process. It is recognised however that there may be updates required in the interim, arising from amendments or release of new regulations, Codes of Practice or statutory provisions or guidance from the Department of Health or professional bodies. These updates will be made as soon as practicable to reflect and inform the Trust’s revised policy and practise.

11. References • RUH Blood Component Transfusion Policy 702 • RUH Transfusion Book: Guideline for the use of blood components and blood

products G723 • RUH Management of patients with preoperative anaemia G748 • RUH Management of massive blood loss guidelines G716 • Royal United Hospital Consent to Examination and Treatment Policy 728 • Association of Anaesthetists of Great Britain and Ireland Management of

Anaesthesia for Jehovah’s Witnesses 2nd edition (AAGBI 2005) • British Orthopaedic Association Blood Conservation in Elective Orthopaedic

Surgery (BOA 2005) • Thomas, Thompson and Ridler A Manual for Blood Conservation 2005. tfm

publishing. ISBN 1 903378 24 9 • Department of Health Better Blood Transfusion Toolkit which can be accessed

at www.transfusionguidelines.org.uk • Cell Salvage in Jehovah’s Witness Patients [2008] UK Cell Salvage Action Group

– ICS Technical Factsheet No 6. Can be accessed at http://www.transfusionguidelines.org.uk/index.aspx?Publication=BBT&Section=22&pageid=1459

• Blood Transfusion Refusal Map of Medicine http://healthguides.mapofmedicine.com/choices/map/blood_transfusion6.html

• Developing a Blood Conservation Care Plan for Jehovah’s Witnesses with Malignant Disease, presented to BSH Annual Scientific Meeting, April 2007 www.transfusionguidelines.org.uk/docs/pdfs/bbt-03_malignant-diseases-v2.pdf

• Maniatis, Van der Linden & Hardy (eds) Alternatives to Blood Transfusion in Transfusion Medicine, 2nd Edition [2011] Wiley-Blackwell ISBN 978-1-4051-6321-7

• Society for the Advancement of Blood Management - http://www.sabm.org/

http://www.transfusionguidelines.org.uk/

http://www.transfusionguidelines.org.uk/index.aspx?Publication=BBT&Section=22&pageid=1459

http://www.transfusionguidelines.org.uk/index.aspx?Publication=BBT&Section=22&pageid=1459

http://healthguides.mapofmedicine.com/choices/map/blood_transfusion6.html

http://healthguides.mapofmedicine.com/choices/map/blood_transfusion6.html

http://www.transfusionguidelines.org.uk/docs/pdfs/bbt-03_malignant-diseases-v2.pdf

http://www.transfusionguidelines.org.uk/docs/pdfs/bbt-03_malignant-diseases-v2.pdf

http://www.sabm.org/


• Network for the Advancement of Transfusion Alternatives - http://www.nataonline.com/

• Gohel et al: Avoiding Blood Transfusion in Surgical Patients (including Jehovah’s Witnesses) Annals of the Royal College of Surgeons of England, 2011; 93: 429-431

• Dhanoa et al: Major Surgery in an Osteosarcoma Patient Refusing Blood Transfusion World Journal of Surgical Oncology 2010, 8:96

• Brown et al: Treatment of a Jehovah’s Witness using a transfusion-free autologous stem cell transplant protocol Community Oncology, 2006: 776-781

http://www.nataonline.com/


Appendix 1: Bristol Hospital Liaison Committee contact details Name Landline Mobile E Mail Richard Dehaney 01225 335411 07962 500514 [email protected] David Smith (chair)

01989 564035 07831 680681 [email protected]

Joel Abbott 0117 382 1922 07414 669307 [email protected] Simon Moore 0117 382 2634 07905 364353 [email protected] Philip Jones 0117 977 8549 07906 990844 [email protected] Mark Hunter 0117 951 5130 07724 099920 [email protected]

mailto:[email protected]







Document Control Information

Ratification Assurance Statement

Dear Tim

Please review the following information to support the ratification of the below named document.

Name of document: Jehovah’s Witnesses and other Patients who refuse Blood Components (783)

Name of author: Helen Maria

Job Title: Transfusion Specialist

I, the above named author confirm that:

• The Policy presented for ratification meets all legislative, best practice and other guidance issued and known to me at the time of development of the Policy;

• I am not aware of any omissions to the Policy, and I will bring to the attention of the Executive Director any information which may affect the validity of the Policy presented as soon as this becomes known;

• The Policy meets the requirements as outlined in the document entitled Trust-wide Policy for the Development and Management of Policies (v4.0);

• The Policy meets the requirements of the NHSLA Risk Management Standards to achieve as a minimum level 2 compliance, where applicable;

• I have undertaken appropriate and thorough consultation on this Policy and I have documented the names of those individuals who responded as part of the consultation within the document. I have also fed back to responders to the consultation on the changes made to the Policy following consultation;

• I will send the Policy and signed ratification checklist to the Policy Coordinator for publication at my earliest opportunity following ratification;

• I will keep this Policy under review and ensure that it is reviewed prior to the review date.

Signature of Author: Date: 3 December 2012 Name of Person Ratifying this policy: Tim Craft

Job Title: Medical Director

Signature: Date: 21 March 2013

To the person approving this policy:

Please ensure this page has been completed correctly, then print, sign and post this page only to: The Policy Coordinator, John Apley Building.

The whole policy must be sent electronically to: [email protected]



Consultation Schedule

Name and Title of Individual Date Consulted Jerry Nolan, Consultant Anaesthetist, Chair of Transfusion Committee

April 2012

Sarah Wexler, Consultant Haematologist April 2012 Kelly Jupp, Complaints & Litigation Manager May 2012 David Smith, Chair Bristol Hospital Liaison Committee for Jehovah’s Witnesses

April 2012

David Walker, Consultant Obstetrician April 2012 Peter Rudd, Consultant Paediatrician and Chair of Clinical Ethics Committee

April 2012

Name of Committee Date of Committee Policy Group 29th June 2012 Operational Governance Committee 11th July 2012 Clinical Ethics Committee 28th June 2012


Equality Impact: (A) Assessment Screening To be completed when submitted to the appropriate Executive Director for consideration and approval. Person responsible for the assessment: Name: Helen Maria Job Title: Transfusion Specialist

Does the document/guidance affect one group less or more favourably than another on the basis of:

Yes/No Comments

Race Yes No Ethnic origins (including gypsies and travellers) Yes No Nationality Yes No Gender (including gender reassignment) Yes No Culture Yes No

Religion or belief Yes No This policy addresses issues of belief

Sexual orientation Yes No Age Yes No Disability (learning disabilities, physical disability, sensory impairment and mental health problems)

Yes No

Is there any evidence that some groups are affected differently? Yes No

If you have identified potential discrimination, are there any valid exceptions, legal and/or justifiable? Yes No This policy addresses

any such issues Is the impact of the document/guidance likely to be negative? Yes No

If so, can the impact be avoided? Yes No N/A What alternative is there to achieving the document/guidance without the impact? Yes No N/A

Can we reduce the impact by taking different action? Yes No N/A

If you answered NO to all the above questions, the assessment is now complete, and no further action is required.

If you answered YES to any of the above please complete the

Equality Impact: (B) Full Analysis