Informed consent

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    I have been working in the OR for a little over 2 years now. From time to time we have arguments with surgeons who are hard headed about their informed consents. For example, yesterday, we had a patient who was given 2mg versed IV and 50mg Demerol IM. Then we noticed on the consent she had signed for a Right breast bx when in fact the patient was to have a left breast bx. Now, it is very rarely we let a patient back to the or before the mistake was caught. So the CRNA gave the versed and then realize the consent was wrong. So the surgeon was told we could not do the case because the consent was wrong. Well of course he had to argue and say his R was an L, when it was pretty clear it was a R. Well then he wrote Left on the consent and had her initial it. Well our policy at our hospital states it is not legal if she had mind altering drugs and of course she did and it was versed and her pre-op of demerol IM. He through such a hissy about it that we ended up calling a sister to say it was OK with the procedure. Now, my question to you is, Do you think it is legal for that sister to OK an elective surgery legally. How do you handle situations like this? Most of the doctors order Pre-ops of demerol and sometimes versed before they even come to Surgery and then when they get to surgery their consent is wrong. I would like some input or sites that issue this kind of information out.
    Thanks!
    Angela, RN
    Last edit by angelaADSN on Aug 8, '03
  2. 7 Comments so far...

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    Angela, sounds like you are in a difficult situation. I have no idea what you state's laws are about informed consent--some have more stringent laws than others. I have frequently seen that surgeons consider informed consent more of an annoyance than anything.
    A great deal hinges on your management and administration--are they more concerned about protecting the patients (and their staff), or are they more concerned about kowtowing to the surgeons? To deal with the consent issue you really need the support of administration, if you don't have this I'm afraid not much with your OR's situation will change.
    Last edit by spineCNOR on Aug 9, '03
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    If I was a surgeon, I would be absolutey ANAL about having all the i's dotted and the t's crossed where informed consent is concerned. Aside from the fact that the patient deserves to know what the surgeon is going to do to him/her, that lame-brained surgeon is just asking for trouble. If something went wrong and he got sued, he'd be defenseless without solid proof of informed consent.

    Bye-bye house in the 'burbs. Bye-bye BMW. Bye-bye country club membership. Bye-Bye blonde trophy wife.
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    As far as our management and administration go, right now they have their ass up a crack. They have to make us the OR staff happy and the surgeons happy. First they try the remark of well, we have to make our doctors happy until OR staff turns in resigations and then it is, "we have to make everyone happy". The DON said it was ok to proceed with this case with a verbal consent from family. What I don't like about the whole situation is, mine and the other nurse that was involved license was on the line. Something we worked hard for. I have no problem standing my ground to administration and telling them "Not with my license!" Chances are there will be no law suit with this case. But if this ever comes up again I want to know if it is actually legal for a sister to sign this consent for an elective surgery. One problem with our OR is our surgeons think if one surgeon did it so can he! So it has to be stopped before it begins. Thanks for your responses. I'm glad there are others who feel this surgeon was in the wrong. You would think he would be grateful for saving his ass. Instead he thought we were doing this to punish him. Thanks again for your replies!

    Angela, RN
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    I think you should consult with risk management in your facility but to my knowlege the family can not sign or consent to an elective surgical procedure unless they are the legal guardian.
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    I thought the same thing. I just need something in black and white that proves it.
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    yeah, consent is such a tricky subject and I find the or staff more aware of the situation then the surgeons. I have had a patient come to the theatre with consent signed by a friend and the surgeon dosent really seem to see a problem with this. I know a few "friends" of mine who'd say, "D.N.R." and not blink an eye. In my situation I got no backup so I filled in a near miss form to cover myself. scary!
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    Too bad I am on vacation or I would look up consents from our manual and send it to you. We have a consent manual that is from the state, California, and spells everything out for us. I have gotten pretty good about consents over the past years and can say with confidence at our hospital no elective procedure would be done with relatives go ahead unless they at legal guardianship or there was court order. All of these have to be in black and white on the chart! Fortunately we have a bunch of surgeons who will listen to you in these situations and will back off if wrong. Check with your state nursing board to see if they have a similar consent manual or with AORN for teir recommendations. Good luck, Mike


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