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