So I wanted to get people's feedback on this. My hospital originally had one consent which covered the surgery and anesthesia. Now, we have a separate consent for the surgical procedure (wording had not changed and we still use the same form that covered both originally) and the anesthesia consent.
So today, we were to do a simple cysto stent. I did the pre-op interview in our one day surgery area with the patient and went through the chart. She confirmed the surgery as it's written in the consent, spoke with an anesthesiologist earlier in the AM and all was well in her chart...except we were missing the anesthesia consent. No problem. I grabbed another one, clipped it to the front of the chart, and told the CRNA in the room about it. He said he would take care of it. You can already see where this is going. So my orderly wheels the patient to the OR doors and the CRNA, who had not yet spoken to the patient anyway, checked things over with the patient also and spoke to her about the anesthetic being used for the surgery, and the patient agreed and understood. At the same time, another CRNA came by and started speaking to my CRNA and said he was going to relieve him for a bit for a short break. Somewhere along there, there was a breakdown in communication and the anesthesia consent was not signed. I had to go back into the room to help the scrub and all the while I thought it was signed. Anyway, the patient is positioned, hooked up, and the propofol goes in. The Dr. asked me about something in the chart so I go to look and the first thing I notice is that the anesthesia consent still was not signed. I immediately went to anesthesia about it. Both CRNA's were still in the room at the time and they said don't worry about it and that they'll take care of it. At this point, what can we really do? We pushed forward and once my CRNA came back from his break, both of them approached me about what they did to the consent. They both signed under the witness area where we would normally have two people sign for those who can't sign for themselves and said that it should be acceptable that way. I was going to talk to my manager about it as well as fill out a variance, but since they seemed to be confident about it, I didn't worry about it, and my manager had left for the day (doesn't help to be second call with a ton of add-ons at shift change). The surgery went without a hitch, took 20 minutes, and the patient woke up just fine. In addition, the surgical consent was correct, and the patient did agree to the anesthetic when the CRNA spoke to them about it. Anyway, sorry for the fluffy story, but what does everyone think about this?
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.
Specializes in OR, Nursing Professional Development.
Anesthesia gest the pt to sign their consent and witness it themselves, not the nurse.
You mean the only signatures on the anesthesia consent are the anesthesia provider and the patient? Seems a little off to me- ours require the anesthesiologist, patient, and a witness (usually the preop nurse, sometimes the OR nurse).
You mean the only signatures on the anesthesia consent are the anesthesia provider and the patient? Seems a little off to me- ours require the anesthesiologist, patient, and a witness (usually the preop nurse, sometimes the OR nurse).
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.
Everyplace that I've worked the provider is discouraged from having the patient sign the forms because then the witness is also the provider. The consent should be signed by the patient with someone other than the provider confirming consent and witnessing the signature.
Everyplace that I've worked the provider is discouraged from having the patient sign the forms because then the witness is also the provider. The consent should be signed by the patient with someone other than the provider confirming consent and witnessing the signature.
Yes but that isn't the policy where OP is. If the CRNA was expected to get the patient to sign, then that's what they should have done.
I think this is all interesting but kind of academic or theoretical, was a patient harmed? Was there negligence? I would feel bad if my patient went to OR without the anesthesia consent signed.....but what? Are they going to sue me, the surgery was a success but we forgot to have you sign this form?
Specializes in OR, Nursing Professional Development.
I think this is all interesting but kind of academic or theoretical, was a patient harmed? Was there negligence? I would feel bad if my patient went to OR without the anesthesia consent signed.....but what? Are they going to sue me, the surgery was a success but we forgot to have you sign this form?
I've actually worked with a nurse who was terminated for taking a patient into the OR without a signed anesthesia consent in a non-emergent case. It is against our policy for a patient to enter the OR without all consents signed prior to leaving the preop area unless it's a life/limb/sight threatening emergency. So, maybe not so much patient lawsuit worthy but job loss worthy. And just because a patient wasn't harmed doesn't make sloppy practice right.
nursenellie
5 Posts
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.