Surgical consent forms- using layman terms

  1. Is anyone at a facility that uses "layman" terms on surgical consents? Recently, we are being required to write out the surgical procedure (as indicated by the MD), and also write the surgical procedure in "layman" terms. Apparently this was recommended by corporate lawyers. Sounds great, except for one minor problem. The MD is not the one writing in the "layman" terms, so it is up to the nurse to interpret the surgical procedure, which often times is quite complicated and not even understood exactly what is being done. Nurses have expressed being uncomfortable with this procedure, as it seems like we are having to give informed consent in a way, because what we interpret the procedure to be is what the patient is going to understand and will actually be on the consent form itself. However, we have no choice in the matter.

    Personally, I find this unsafe, and I think it puts the nurse at risk. I would welcome any input, especially from others that work at a facility that is doing this also.
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  2. 16 Comments

  3. by   Charles S. Smith, RN, MS
    This is not a corporate lawyer requirement. The basis of this practice is to elicit from the patient the procedure she/he is having in her/his own words. You are not supposed to write it out yourself unless your policy states you are to do it this way. I believe it stems from JCAHO requirements, but comes under laws regarding informed consent. Be very well informed per your hospital policy here.
    chas
  4. by   P_RN
    That's one more reason for the physician to be the one obtaining the permits. IMHO

    P
  5. by   NicuGal
    I didn't realize that nurses were able to get consent...in our hospital, only docs and nurse practioners can get consent. We have a standard consent and then they write in the chart what they told the parents/patients. Interesting.
  6. by   Charles S. Smith, RN, MS
    In many hospitals now, the informed consent signature line states something like "witness to signature only" indicating that the nurse is only witnessing the signature of the patient or legal rep of the patient. Also, there may be a place for the MD to sign and date stating that she/he completed all informed consent process and the patient understands/agrees. I do not have the consent signed unless the MD has signed first or I was witness to the whole informed consent process. In this way, my responsibility as the patient advocate is not breached. We all have the duty of patient advocacy as a primary requirement and responsibility of licensure.

    chas
  7. by   All41
    AORN states that informed consent is the responsibility of the surgeon. This should be the basis for correcting the confusion. For a nurse to interpret what a doctor has written is extremely dangerous. The nurse should be responsible, ONLY, for making sure the patient understands the consent and documenting the response and/or the action taken to correct the situation. This is my interpretation and I would be interested to see others. Thanks!
  8. by   SRainny9
    Thanks for the input. We are currently asking patient's their understanding of the procedure and some nurses thought that is what they were suppose to write on the layman terms section of the consent. However, the answer we received from our superiors was no, that is not what we are to put. Sometimes, the patients know little about what they are having done (kidney stone surgery, shoulder surgery, etc.), and it's not always exactly right. So, we (the RN) are writing the layman terms. Again, we have expressed our discomfort about this, but it is a corporate decision. As far as I know, we have no policy and procedure on this yet. We don't have any type of standard layman terms to use. It's what each nurse feels comfortable writing, and I think it puts us in a very touchy spot. It's our licenses, not our superiors, that are on the line. I wonder about the legal implications of this, should something be worded wrong. The MD normally signs the consent prior to surgery after it's been witnessed by an RN in the preadmission process. So, we have no idea what the MD actually told the pt, except what the pt says.

    I wonder if the corporate lawyers had the idea that the MD would be writing layman terms, and if they have any idea that nurses are "interpreting" the procedure.
  9. by   P_RN
    You should NOT be writing anything on that form except your witness to the patient's signature and the date.

    Unless you want to be getting your OWN attorney, you need to refuse any attempt to make you a part of this harebrained idea.
  10. by   All41
    What is up with "but this is a corporate decision"? My mom always told me that every body has a boss and that has served me very well in life. I would never allow a non-licensed anyone tell me I had to do something that I knew to be incorrect. (Now you know why I am so popular Seriously, if you are backed into a corner, contact your State Board of Nursing and ask for assistance. If a doctor told you to give the wrong drug during a code and you knew it would kill the patient, would you do it? I think not and this is the same thing in my opinion. P RN put it best. When the chips are down, you are the only one going downtown for your actions.
  11. by   meandragonbrett
    The nurse doing the pre-op, the surgeon and the pt. have to sign consent forms at my place.

    brett
  12. by   SRainny9
    Appreciate all the feedback. It's not just "corporate" telling us to do this. It is coming from RN managers and director of nursing also. We now have a "guideline" that has a lot of procedures, and is in accepted layman terms. This was obtained from another hospital that has been doing this for quite a while.

    I agree that it is up to me to be responsible for my license. I have been using layman terms if its in the "guideline" reference tool or if it's straightford: hysterectomy, etc. If it's an involved procedure or I'm not sure about it, I leave the layman terms area of consent blank. I figure if someone complains, then I'll have more grounds to say why I'm not doing it.
  13. by   jean67
    We are a small facility, a critical access facility in a very rural area. On our Op consents we have a "line" where the patient writes in their understanding of the procedure. Or if they can't write it themselves we write in quotation marks what the patient tells us. under that line we have another line where the actual medically correct name for the procedure is written out. When we witness a consent we are only witnessing that we observed that the patient themselves signed the consent for procedure form.
  14. by   brownbook
    We don't do any of that yet. But I like the way jean67's facility does it. It makes no sense for patients to be signing for procedures with anatomical or medical terms they don't understand.

    But for the nurse to be interpreting in her own words what the doctor's consent to read means is not the way to do it.

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