Should you perform a blood-alcohol test?
Should you perform a blood-alcohol test?
The legal implications of doing a blood alcohol test on a trauma patient under the influence vary from state to state. Emergency department (ED) nurses may be requested to draw blood for legal blood-alcohol level or witness the procedure.
"Policies should be in place that describe the role of the ED nurse in obtaining specimens so that the chain of evidence’ is not breached, for both the patient’s and any victim’s sakes," stresses Renee S. Holleran, RN, PhD, chief flight nurse and clinical nurse specialist at University of Cincinnati Medical Center.
Five states have passed laws allowing results of blood alcohol levels to be shared with the authorities: Illinois, Oregon, Hawaii (mandatory), New Hampshire, and Indiana. Be familiar with your state laws to reduce legal risks. Even if your state has laws allowing the results to be shared with authorities, you still could be liable for a civil suit.
"A lot of states will absolve you from civil but not criminal liability," says Pat Southard, RN, JD, associate hospital director for Oregon Health Sciences University in Portland.
Most emergency personnel say the results of blood-alcohol tests should remain confidential. Caregivers should put the best interests of the patient first, says Carl A. Soderstrom, MD, FACS, director of physician education at R. Adams Cowley Shock Trauma Center in Baltimore. "If Joe got injured while drunk on the job, maybe the insurer won’t pay the bill, or maybe Joe gets fired," he notes.
How do you get away with testing?
However, there are good clinical reasons for testing blood-alcohol levels.
"To detect alcoholic patients, nurses often want to know how to get away with testing," notes Soderstrom. "The answer is, you need to be testing patients for alcohol and other drugs for clinical reasons, not legal, surveillance, or research reasons."
Sound clinical reasons include detecting those at risk of substance withdrawal (including alcohol), anesthetic and pain management, and to screen for substance use disorders, such as alcoholism, Soderstrom emphasizes.
"There’s a whole volume of literature that says if a patient is injured and intoxicated, there’s a good probability they have a drinking or other drug use problem," he says. (For more information, see recommended reading list, below left.)
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