The document summarizes a case study examining informed consent forms used in Kuwaiti hospitals. Students reviewed 41 anonymized consent forms and identified issues using Burton's reflection model. They found consent forms missing critical patient information like name, signature, and procedure details. Students felt uncomfortable that issues could persist despite accreditation requirements. However, they were committed to improving patient safety and ensuring informed consent is properly obtained.

1. Al-Braheem A [1]
, AlRasheedi S [1]
, Borahmah A [1]
, Elamir H [3]
, Jacob S [1]
, Bouhaimed M [1,2]
[1] Department of Community Medicine and Behavioural Sciences, Kuwait University Faculty of Medicine.
[2] Department of Surgery, Kuwait University Faculty of Medicine.
[3] Department of Quality and Accreditation, Mubarak Al-Kabeer Hospital, MOH
Is The Accreditation Program Enough To Ensure Patient Safety?
A Students' Reflection On A Patient Safety Required Area
Background:
Learning consists of cognitive, emotional and social dimensions. In medical education, the cognitive dimension is usually measured through assessments of performance (Fig 1), while the social and emotional
dimensions are more challenging to capture. Developing a protocol containing informed consent completion as a part of the pre-intervention patient’s verification is a patient safety required area mandated by
The National Accreditation program to ensure performance of correct procedure at correct body site. Completion of the consent is required by medical records regulations as well. The informed consent is not
merely a form but an internationally accepted way of communicating verified information about the patient, the procedure and the surgeon through an actual process that entails a doctor-patient interaction
(Fig 2). The objective of this case report is to focus on the use of informed consent forms as an educational tool during the elective course “Patient Safety: Better Knowledge for Safer Care”.
Case Summary:
The Burton’s approach to reflection (Fig 3) with the 3 core questions of: What? So What? Now What? was used during the assessment of
masked non-identifiable consent forms retrospectively reviewed as part of a hospital based audit. The WHAT? component revealed: Total of
41 masked informed consents were used during this ethical analysis to identify the deviation from the standard of care and the potential
ethical and safety issues relevant to the review. The findings were as follows:
Conclusion:
The Burton’s reflection approach was successfully used
as a tool in teaching a clinical ethics course on patient
safety.
Contacts:
For further information, please contact:
Dr. Manal Bouhaimed
Email: manal_q8 @hsc.edu.kw Tel(office): 24636532
Acknowledgement:
We would like to acknowledge the assistance provided by Quality Nurses:
Abeer G. Dossokey, Amal T. Mohamed, Asila A. Alrasheedi, Lea Martinez &
Rinto Francis.
Remembering
Understanding
Applying
Analyzing
Evaluating
Creating
1. Bloom, Benjamin (ed.). Taxonomy of Education al Objectives. Handbook I: Cognitive Domain. David McKay Company, Inc. New York: 1956.
http://pcs2ndgrade.pbworks.com/w/page/46897760/Revised%20Bloom's%20Taxonomy
Fig 1: Bloom’s Taxonomy (Revised)
Can the student distinguish
between different parts?
Appraise, compare, contrast, criticize,
differentiate, discriminate, distinguish,
examine, experiment, question, test
Define, duplicate, list, memorize,
recall, repeat, state
Can the student recall or
remember the information?
Can the student explain ideas or
concepts?
Can the student use information
in a new way?
Classify, describe, discuss, explain,
identify, locate, recognize, report,
select, translate, paraphrase
Choose, demonstrate, dramatize,
employ, illustrate, interpret, operate,
schedule, sketch, solve, use, write
Can the student justify a stand
or decision?
Appraise, argue, defend, select,
support, value, evaluate
Can the student create a new
product or point of view?
Assemble, construct, create, design,
develop, formulate, write
The SO WHAT? component revealed the students’ uncomfortable feelings and thoughts especially at a time when there is a national
accreditation program in the country. The NOW WHAT? component showed a clear commitment “to do the right thing”
and “first do no harm”.
The students found two different versions of Consent Form that are used in MOH hospitals, with critical findings related to the contents of
both (Fig 5).
Patient’s Full name
(missing in 9.5%)
Patient’s Signature
(missing in 4.9%)
(present but in a different language
than the one patient use in 7.3%)
Procedure: Name,
site, Side, Level
(missing in 12.2%)
Abbreviations used
(in 19.5%)
Doctor’s Name
(present in 100%)
Date of Birth
(missing in 100%)
Medical Record Number
(missing in 9.8%)
Doctor’s Signature
(missing in 12.2%)
Fig 4: Findings of
Consent Form Audit
Fig 5: Two versions of Consent Form
DO IT.
What?
What happened?
What were the
results?
Now What?
What will I
do differently
next time?
So What?
What do these results imply?
How did I influence the
outcome?
Fig 3: The Burton’s approach to reflection
Fig 2: Doctor-patient interaction