Consent: Are we doing it right?
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Orthopaedic audit @ Royal Derby Hospital, Spring 2015. Consent forms are not being adequately filled out.
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Consent: Are we doing it right?
- 1. Consent: Are we doing it right?Guy Stanley Dr. Mohammed Ali Mr. Aspros Supervisor : Mr. Tambe
- 2. INTRO •Consent: medicolegal and ethical •Problems? • Jargon • Missing info • Inexperienced juniors •Loose guidelines exist: BOA (1), Dept. of Health (2) & GMC (3)
- 4. 1. Evaluate the objective measures: A. Dates and signatures. B. Jargon. C. Benefits. D. Allocation of the patient’s copy. 2. Acknowledge the subjective. 3.Look at the link between consenters’ job grades and consent quality. AIMS
- 5. MATERIALS AND METHODS •Retrospective review of consent forms. •70 elective procedures (no trauma) from wards 202-206. •Only Type 1 (competent adult) consent forms used.
- 6. WHAT ARE WE DOING WELL ? •All consent performed less than 2 months before procedure. •All operations clearly titled * •Every form signed by patient + doctor •Risk & benefits had something written
- 7. WHERE COULD WE IMPROVE ? •29% of forms didn’t have patient label / ID. •14% (10/70) of patients had copy. •Jargon in 34% (24/70) e.g. Acronyms like PE, DVT. •Procedure written in CAPITAL LETTERS in 24% (17). •Risks 96% recorded (67/70)
- 8. LINK: JOB GRADE CONSENT QUALITY? • Consultants (10 forms): 4 labelled correctly • Registrars (24 forms): 1 had no important risks • Core Trainees (34 forms): 30 labelled correctly, 2 missed important risks • F2s (2 forms), insignificant number 0.00% 20.00% 40.00% 60.00% 80.00% 100.00% Label Pt's copy Cap letter Med terms other procedure Consultant Registrar CT
- 9. RECOMMENDATIONS • Developing training sessions for junior doctors • Have registrar / consultant take consent • Go digital: • Recommend digital signatures & forms for all procedures • Use orthoconsent.com - endorsed by the BOA • Re-audit
- 10. CONCLUSION •Trainees may benefit from consent training •Remember, a patient’s signature is evidence of giving consent NOT proof of ‘valid informed’ consent…
- 11. REFS 1. Finsbury Orthopaedics/British Orthopaedic Association (BOA), Consent form, http://www.orthoconsent.com/ 2. GMC Consent: Patients and Doctors Making Decisions Together (2008), http://www.gmc- uk.org/guidance/ethical_guidance/consent_guidance_index.asp. 3. DOH), Reference Guide to Consent for Examination or Treatment, Department of Health, 2nd edition, 2009, 11911 https://www.gov.uk/government/uploads/system/uploads/attachment_data/fil e/138296/dh_103653__1_.pdf
Editor's Notes
- A consent form is NOT a legal document - it confirms consent ! It can be important in medicolegal cases and to confirm the patient agreed with a plan of operation GMC Guidelines (1998) stress the need to obtain consent as risk of litigation BOA orthoconsent website has been OFFLINE GMC guidelines available - suitably wishy washy
- Patient copy: acts as reminder of what’s been discussed & patient can refer to if later NOT A LEGAL REQUIREMENT However if it isn’t given and you don’t tick the ‘accepted by the patient’ this won’t help in court
- Dates & sigs: GMC “consent should ultimately be obtained by the person performing the operation, having sufficient knowledge to discuss the procedure, including potential risks.” Acknowledge the subjective evaluation Risks: subjective interpretation at my level of experience. Although included, would not link it to consent ‘quality’. In future we would redo this, splitting patients into 7 procedure groups: hip replacements, knee replacements, shoulder repairs. Ask a consultant of each speciality to provide a list of risks. Compare to that. Legibility – use of capital letters Other procedures
- * HOWEVER! We did not note whether the side of the operation was listed – an appropriate measure to use when we redo the audit
- ALL consent must list risks & benefits according to all guidelines – howeverwhile there WERE risks recorded for every procedure in 3 cases, infection and bleeding were missed out.
- Develop tips for all: Spare the JARGON LABEL every page (including the patient's copy) Write in BLACK CAPS Give the patient a COPY Redo audit: Objective measure for risks Objective measure for legibility (black ink, CAPS, jud Determine if SIDE of the body is listed Obtain a consent quality score, then encourage juniors to use orthoconsent to see if this improves matters
- Consent is often wrongly equated with a patient’s signature on a consent form. Although the signature is evidence that the patient has given consent, it is not proof of valid informed consent.