Telephone Consent question

  1. What are y'alls policies regarding telephone consents? We had one today where the 16 year old patient had a consent signed by his grandfather, who is not his legal guardian (thanks, pre-op!) I had to call North Carolina to get consent from mom over the telephone. Surgeon and myself talked to the mother and got consent, we both signed the form. CRNA also discussed case with mom but didn't sign the surgical consent. I then got my assignment switched to go into the room and circulate the case. Normally we have someone not on the OR team witness consents, but we really don't have a "normal" telephone consent procedure. I am in a bit of hot water for signing as a witness and doing the case, but I should be fine as there was no one else qualified to circulate it (assigned nurse did not show up) and my assignment was switched after I had witnessed consent. I guess I am wondering, should we have called again to have someone else verify consent?
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  2. 10 Comments

  3. by   IamRN
    Quote from armyrn
    Normally we have someone not on the OR team witness consents, but we really don't have a "normal" telephone consent procedure.
    Would not the general hospital's policy apply in all surgical consent situations?

    It is generally considered conflict of interest for surgeon to sign the consent; as a witness and/or for giving consent. Having said that, I just had a situation where the physician needed to sign a consent because there was no next of kin available, however, in that case another physician's signature was required. Two RN'switnessed.
  4. by   rjflyn
    You dont specifiy in your post if this was a routine procedure or an emergency. If routine we would have not done the surgery. That being said:

    Several years ago a hospital i worked in on a saturday afternoon had a friend of the family bring a 4 year old boy whom nearly bit his tounge off. His mom and day were truck drivers out on a trip and didnt have a cell phone at that time. No other family member could be reached at the time- the friend was watching the child and had no other contact numbers.

    At that time the hopital administrator on call ie VP or higher was the one consulted and consented for this child to go to the OR- if it had not been an emergency the child would have waited until the parents could have some how been contacted.
    Rj
    Last edit by rjflyn on Jun 23, '04
  5. by   armyrn
    the surgeon signed for having discussed the procedure, not as a witness. this was an emergency procedure. hospital legal told me today that i did the best i could have under the circumstances, so i'm OK.
  6. by   IamRN
    Quote from armyrn
    the surgeon signed for having discussed the procedure, not as a witness. this was an emergency procedure. hospital legal told me today that i did the best i could have under the circumstances, so i'm OK.
    That's good news!

    I am still wondering though....should not the telephone consent have been witnessed by two nurses?
  7. by   odatrn
    I believe our policy requires two doctors signatures, usually it is the surgeons and the ER doctors that we get. Only for emergencies, and I have personally only used the policy once in 18 years.
  8. by   shodobe
    In California the only two people required are two "health care workers". This means it can be a work clerk, CNA , LVN or RN. MDs DO NOT sign a consent. It is the responsibility of the surgeon to make not in "his progress notes" that a surgery is deemed an emergency. The tw MD signatures has been a "myth" for many years but they still seem to think it is a requirement. Never once in 27 years as an OR nurse has a ER doc signed anything close to a consent. What I am referring to above is out of the CHA manual on consents. If someone wants I can get them the particulars on the book and send it to them. Please PM me. I know each state is different so don't let what we do in California steer you wrong. Mike
  9. by   Dixiedi
    Quote from armyrn
    What are y'alls policies regarding telephone consents? We had one today where the 16 year old patient had a consent signed by his grandfather, who is not his legal guardian (thanks, pre-op!) I had to call North Carolina to get consent from mom over the telephone. Surgeon and myself talked to the mother and got consent, we both signed the form. CRNA also discussed case with mom but didn't sign the surgical consent. I then got my assignment switched to go into the room and circulate the case. Normally we have someone not on the OR team witness consents, but we really don't have a "normal" telephone consent procedure. I am in a bit of hot water for signing as a witness and doing the case, but I should be fine as there was no one else qualified to circulate it (assigned nurse did not show up) and my assignment was switched after I had witnessed consent. I guess I am wondering, should we have called again to have someone else verify consent?
    It's been quite a few years since I worked in a hospital but at that time 2 nurses listened in on the phone (pt family member knew) and then everybody signed as witnesses. That usually gave 4. The surgeon, 2 nurses and the anestesiologist (crna).
  10. by   armyrn
    Quote from shodobe
    In California the only two people required are two "health care workers". This means it can be a work clerk, CNA , LVN or RN. MDs DO NOT sign a consent. It is the responsibility of the surgeon to make not in "his progress notes" that a surgery is deemed an emergency. The tw MD signatures has been a "myth" for many years but they still seem to think it is a requirement. Never once in 27 years as an OR nurse has a ER doc signed anything close to a consent. What I am referring to above is out of the CHA manual on consents. If someone wants I can get them the particulars on the book and send it to them. Please PM me. I know each state is different so don't let what we do in California steer you wrong. Mike
    thanks. the surgeon did not sign as a witness. our surgeons have to sign the consent form to indicate that he did counsel the patient/guardain on procedure, risks, and benefits. we are a military hosp., so not governed by individual state rules as far as things like this go.
  11. by   Gompers
    For our telephone consents, we just need the surgeon talking and a nurse listening on the phone with the parents, and then both sign the consent. We get them pretty often, and follow the pre-printed instructions on the hospital's surgical consent form.
  12. by   Dixiedi
    Quote from armyrn
    thanks. the surgeon did not sign as a witness. our surgeons have to sign the consent form to indicate that he did counsel the patient/guardain on procedure, risks, and benefits. we are a military hosp., so not governed by individual state rules as far as things like this go.
    Ya'll are right on that, here too. I was counting the number of people on the phone without completing the thought. DAH!

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