Consent issue

this sounds like a simple case of someone was too lazy to do things properly so they half-a$$ed it and called it "good enough." good enough never is, in my opinion... and laziness is my #1 pet peeve.

Yeah an error was made. I certainly can not see how any harm was done to the patient or any legal action could come out of this?

Laziness is not my pet peeve.....stupid redundant paper work made for and written by lawyers and insurance companies is my pet peeve.

I think.....assume....maybe.....that the wording of most surgical consents mention anesthesia.

It may come down to an issue of when, how, why, anesthesia gets paid, gets billed separately from the surgeon per their insurance.

Sounds like anesthesia should have had that covered before the patient was brought in...the anesthesia provider should be aware of whether the consent is signed or not...but you know who it would fall back on..the nurse!

Sounds like anesthesia should have had that covered before the patient was brought in...the anesthesia provider should be aware of whether the consent is signed or not...but you know who it would fall back on..the nurse!

And that's absolutely my concern. I spoke with my team leader today and she just said to go ahead and fill out a variance anyway so I did. But she said that it's still covered under the operative consent since the wording was never changed and not to worry about it. Per management, the anesthesia consent was created to provide more backbone to legal cases only. Billing was not mentioned. They've been doing audits on themselves to see if they've been filling them out thoroughly and correctly, and so far, according to my manager, they're at 95%.

No patient should enter the OR until all consents / H&P update / any other requirements are met. Period.

So a little background on our hospital. The process of bringing our patient over use to go like this...Pre-op would get the patient ready and notify us in the OR that they are ready for pick-up. The orderly would go pick-up the patient and bring them back to the OR were we would do our patient interview/assessment outside of the actual OR room. Anesthesia would also do their assessment. We would bring the patient in, have them transfer to the OR table, and the surgeon would place a mark on the patient before anesthesia pushed meds in. At this time, H&P's outside of our 24 hr acceptable window would be updated in the room. After the surgery was completed, anesthesia and the orderly would take the patient to recovery and anesthesia would give report to the recovery room nurse. As you can see, this system isn't the best, but it has worked for many years.

Fast-forward to a month ago. Our new process goes like this...the Dr has to see the patient in pre-op to mark laterality only. If no laterality marking needed, they don't have to see the patient unless the patient has questions beforehand. H&P updates remain the same. The circulator has to speak with the patient in pre-op before we can bring the patient back. Anesthesia does not. They can still see the patient outside of the OR. Without anesthesia talking to them about the anesthesic, we can't get the anesthesia consent signed. Therefore, your argument, although valid, leads us to a conundrum that has been beaten to death and would be so easy to fix if our anesthesia group were not so resistant to change or have such a huge sense of entitlement. Our current process is still flawed and management promises us that they are actively working towards a mutual resolution. It's hard to get anesthesia to see the patient in pre-op because...wait for it..........it's too far to walk. The distance from the farthest OR suite to the farthest pre-op patient room is 1/5th of a mile, one way. Therefore, some anesthesia sees the patient in pre-op and some want the patient brought to the door still.

The RN should pick up the patient...make all the necessary checks to see everything is filled out correctly...its your license...and we are the "final" check before the patient comes back to the room. Period. The circulating nurse is responsible for the care of the patient in the OR....not the preop nurse. Who checks to make sure pre op did what they should before the patient comes back?

I'm not seeing what the problem was, the CRNA/anesthesiologist already consented the patient, all that was left was for the nurse to have the patient sign the form and witness the signature, what else was the CRNA expected to do?

all Dr.s, anesthesia and nurses see patients in the preop holding area at my hospital . The anesthesia providers cannot(or atleast shouldn't-it has happened) bring patients back until the circulator signs the nurse to nurse handoff. So usually what ends up happening is anes calls a million times into the room, can we come back yet-can we come back yet?

no patient comes back with incomplete consents, period.

I'm not seeing what the problem was, the CRNA/anesthesiologist already consented the patient, all that was left was for the nurse to have the patient sign the form and witness the signature, what else was the CRNA expected to do?

The CRNA was expected to get the patient to sign the paper work. My problem with this whole situation is that no one in the OR is talking to the patient until they get into the OR.

It is very different where I work. One where everyone is accountable. I am really shocked by all these comments. The doctor gets the pt to sign their consent. Anesthesia gest the pt to sign their consent and witness it themselves, not the nurse.. The OR nurse checks to make sure both consents are signed, along with checking that the site is mark, the H&P is done or updated, and is on the chart, along with all the pre-op questions we ask the pt. This is all done in the pre-op area and NO pt comes back into the OR until all these measures are done. Everyone is accountable and liable.