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Consent and documentation
- 2. Consent • Consent' is a patient's agreement for a health professional to provide care. • Different forms of consent • Implied - indicate consent nonverbally (for example by presenting their arm for their pulse to be taken • Oral • Written
- 3. Four elements of a consent in a patient Understanding – Able to understand the procedure 1 Retaining – Can be able to retain the information 2 Deciding - can make a decision based on that information 3 Communicating - communicate that decision to the carer by signing the consent form 4
- 4. For a valid consent Patient must be • be competent to make the particular decision • have received sufficient information to make the decision • not be acting under duress • If one of the above elements is missing, then consent has not been adequately obtained
- 5. Competency - Decision making capacity Capacity consist of following 3 criteria • the ability to comprehend and retain information • a belief in the information given • the ability to use the information given to arrive at a decision
- 6. Decision-making capacity is not black and white A person may have capability of making some decisions but not others Capacity may vary with factors such as confusion, panic, shock, fatigue, pain or medication
- 7. Assessing capacity The assessment of capacity needs to be made at the time the decision is needed. Because a woman lacks capacity to make a decision on a particular occasion, does not say that they lack capacity to make any decisions at all, or will not be able to make similar decisions in the future If you have doubts seek help from • Nurses • Those close to the patient • Colleugues – Ex psychiatrist, speech language therapist • Legal advise
- 8. If not competent • family members • court-appointed guardians • or others (as determined by state law) may act as "surrogate decision-makers" can make decisions on behalf of a person
- 9. Disclosure of information Information should include • Details of the procedure • the benefits, and likelihood (or probability) of benefit • the risks and likelihood (or probability) of each of the risks • Other alternative options • Any questions you have should be fully explained
- 10. Montgomery case Nadine Montgomery was a woman with insulin dependent diabetes who gave birth by vaginal delivery. Her baby, Sam, was born with serious disabilities after shoulder dystocia during delivery. The consultant obstetrician did not tell Montgomery of the 9–10% risk of shoulder dystocia. The obstetrician said that she did not routinely discuss the risk of shoulder dystocia with women with diabetes for fear that, if told, such women would opt for a caesarean section. The court held that the obstetrician should have informed Montgomery of the risk and discussed with her the option of a caesarean section.
- 11. Children under 16 years The Gillick ruling in 1985 for treating minors in the UK without their parents' consent. • Minors of any age who are able to understand what is proposed and have "sufficient discretion to be able to make a wise choice in their best interests" are competent to consent for medical treatment. At 16 years it is presumed to have competency Below 16 years they must demonstrate their competency
- 12. Special situations • Mentally ill patient – Can be detained without consent
- 13. Example of a content of a consent • Name of the procedure • About the procedure – Preparation prior to surgery, Aneasthesia, Incision, Steps of the procedure • Recovery period – What to expect and management (ex- pain and analgesics, mobility, meals), duration of stay • Follow up • Benefit of the procedure • Complications and their prevention or management (ex – DVT and stockings) • Alternative treatments and importance of surgery • Statement of the patient
- 15. Documentation • Very important • Legally bound for years • Contemperaneous documentation is more important than retrospective
- 16. Componenets • Patient identification • Date and time • Details in chronology • People attending and their contributions • Signed and named
- 18. Thank you