Anaesthesia and peri-operative care for Jehovah's Witnesses and patients who refuse blood 1. Patients should be given a clear explanation of the blood products that the medical team looking after them consider might be required during or after surgery, and the risks involved if they refuse. Discussion of alternative treatments should be undertaken if available. 2. It should be clearly documented in the medical record which treatments and/or procedures the patient consents to and which they do not. 3. At least 6 weeks before elective surgery likely to be associated with significant blood loss, the patient's Hb should be checked and if < 130 g.l—l, optimisation by treatment with iron and/or erythropoietin should be considered. 4. All relevant issues should be highlighted at the time of the team briefing and during the surgical safety checklist before induction of anaesthesia. A specific checklist recording which components/products/procedures the patient will or will not accept should be available. 5. The majority of Jehovah's Witnesses will accept intra-operative cell salvage - this should be discussed before surgery and if agreed set up from the start of surgery. Consent should be obtained. 6. The interventions promoted as part of a 'patient blood management' approach should be rigorously applied, including tranexamic acid administration for major surgery. 7. After surgery, a comprehensive verbal and written handover of the patient is essential. Staff should be made aware of any adverse intra-operative events and should understand and respect the wishes of the patient that will have been discussed before the procedure. #Jehovahs #Witnesses #Anesthesia #perioperative #preoperative #Management #Checklist
