Consent: Are we doing it right? Guy Stanley Dr. Mohammed Ali Mr. Aspros Supervisor : Mr. Tambe
Consent:Are we doing it right?
Guy Stanley
Dr. Mohammed Ali
Mr. Aspros
Supervisor : Mr. Tambe
INTRO
• Consent: medicolegal and ethical
• Problems?
• Jargon
• Missing info
• Inexperienced juniors
• Loose guidelines exist: BOA (1), Dept. of Health (2) & GMC (3)
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
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.
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
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)
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
ConsultantRegistrarCT
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
CONCLUSION
•Trainees may benefit from consent training
•Remember, a patient’s signature is evidence of giving consent NOT proof of ‘valid informed’ consent…
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/file/138296/dh_103653__1_.pdf