Surgical consents

[Cheyenne RN,BSHS]

I have recently returned to working on the medical floor. I have been a nurse since 1985, so I am not new, and I try to stay current with new surgeries, tests, and procedures.

At the facility where I currently work, the doctor's and anesthesiologist's do not have their consents signed, but leave it to the nursing staff. The nurses have always accepted that responsibility because the "doctor's are so busy."

Sometimes the anesthesiologist does not even see the patient or their chart until they roll into surgery. They will call and ask the nurse assigned to that patient fifty-trillion questions as they order you to get the permit signed "before they come up."

Several times I have had patients tell me they were uncomfortable signing the consents or did not want to sign until they talked to their doctor.

I have refused to have the consents signed on numerous occasions and was taught that nurses are to witness "signature" only. I do not believe that "explaining" the procedure and the risks and marking any "additional" procedures is within my scope of care. Specially since the cardiac caths are done at a hospital across town.

My nurse manager is supportive and is also new to this facility. He says that I am right not to have anyone sign if they are unsure. I believe that I am doing the right thing, but it certainly is not popular the doctor's or the other nurses who think I just want to make waves.

Am I doing the right thing? Any comments would be very much appreciated.

[Zinnia]

The nurses get the consent signed with a doctor's order at my hospital. It says right on the consent 'the physician"____" has exlpained the procedure to me.' We fill in the surgeon's name. On that same form is the consent to anesthesia. We get that signed too. The preop checklist requires Pre-op to check that everything is signed ,that there is a blue ink X on the affected part,(the patient actually makes the X,if they can),and that they are all again signed by the doctor.

We are pretty lucky here that the anesthesia doctor makes rounds to talk to the patients before surgery.

[cwazycwissyRN, RN]

If a consent has been filled out completely by the doctor, the doctor has explained the details to the patient and has signed the consent himself......stating he has educated the patient, and the patient concurs that the physician has explained the procedure and the risks involved and understands and has no further questions.........then and only then will I have a patient sign a consent. I am only withnessing their signature. Never do I have a patient sign a consent that is blank. Never do I fill out a consent for the doctor. When I recieve a patient from the floor that has a blank consent that has been signed......I tear it up. Seems harsh, but I do feel this is illegal. Pt. advocate.

I once picked up a lady for a c-section whose consent stated" sea section" and was written like a child.....signed and witnessed. There was no doctors signature on it. I ask the patient who reviewed the consent with her....she told me she was told to fill in the blanks and sign it:rolleyes: Yup another one in the trash.....and one nurse saw the rath of my anger.

In any facility I have worked in, this is the job of the doctor. In every facility I have worked in....they try to get the nurses to do it.

OR RN

[Tweety, BSN, RN]

Originally posted by Fire Wolf

I guess what I am really asking is what exactly is the legal responsibilty of the nurse in getting a consent signed and what is the physicians?

When are we out of our scope of care?

You are not out of your scope of care having the patient sign the consent. As has been said you are only the witness that the patient is indeed the patient.

Informing the patient of the risks and benefits of the procedure is the MDs.

I just go into the room with a pen, and ask the patient to sign if the MD has talked to the patient. I don't really say much, as I am only a witness that the patient is signing it and not someone else.

MDs are infamous for trying to get consent before talking to the patient for their own convenience. Don't do it.

Also, remember never to get consent on one who has recently been medicated. That can bite you in the butt later.

I noticed our consents the last year or so has added a paragraph for the MD to sign, "I have explained the risks and benefits, etc...." This isn't always signed until later though, but usually gets signed.

[Edward,IL]

You are best to keep separated from surgeons.

1) The general consent for admission and treatment gets the patient inthe hospital door and gives consent for ROUTINE nursing and medical care without fear of a charge of battery.

With this consent, for example, you can ask the patient to disrobe so that you can perform a physical exam, collect urine, feed the patient, etc.

2) Any additional procedure (endo, minor surgery, chemotherapy, blood products) that may remotely involve risks to patient or be considered by anyone to be beyond the realm of ROUTINE should have the consent of the patient BY THE PERSON WHO IS GOING TO DO THE PROCEDURE. The patient always has the right to refuse any or all of medical treatment.

During the course of even routine care, I always explain to patient prior to their care what I am going to be doing to allow them the chance to say 'no". This has always served me well.

Make the MD's get their own consents signed!

Just my humble opinion, Edward, IL

[zambezi, BSN, RN]

At the hospital that I work at, the doctors explain the procedure to the patient and the patient's family. We have a standard consent form...they write and order for the consent after their explanation...after the doc has explained the procedures, we go in the patients room, usually show the patient a video of the surgery, do pre/post op teaching, read the entire consent form and have the patient sign...after the video, i ask the patient to review what the doctor discussed with them, if the patient does not feel that the procedure has been explained well enough by the doctor, they do not have to sign until their questions have been answered...usually it goes well, i think that i have only not had the consent signed once or twice, at least our docs are pretty good about more teaching if that is what the patient needs/requests...

[nialloh, RN]

Originally posted by bklynborn

ok here's one for you............which tests need a consent? mri, ct....I am still not sure.........................

You only need concent for an MRI or CT if you are going to use iv contrast/GAD

[TinyNurse, RN]

I'm a new grad as of Friday, but as we learned in school, it is up to the physician to get the consent signed ( i even had that question on my exit HESI)

I know it is the nurses responsibility to double check that it IS signed, but i dunno.

I would probably address the physician regarding this since it is beyond the RNs scope.

xoxo

Jen

[sehbear]

I use this basic rule of thumb....

Whoever (or is it whomever??) is performing the procedure should gain consent, either verbal or written depending upon the type or procudere.

But every state and country are different so check it out in your own neck of the woods

As with most things in nursing ... if you are uncomfortable doing it don't!