Consents from patients who cannot sign for self

[Chilly_hands]

Question: how does your surgical department obtain consents for surgery, anesthesia, hippa, consent for treatment at facility?

The hospital I work at has several forms for signature for a surgical patient. My biggest issue is the patient who is challenged and cannot sign for self and either has a family member to sign or patient is a ward of the state and some judge or unreachable person is the one who signs. The issue is when the patient is with the group home staff, etc. and the responsible party must be reached by phone. Usually the case is the earliest case, no offices are open for phone consents. This has resulted in procedure delays and even cancellations.

I have ideas of how to correct this problem but would like some input from others. So, answers to the questions below would be fantastic.

1. Are consents completed prior to surgery day and by whom?

2. Are anesthesia consents obtained prior to surgical day and how is this done?

3. Is preadmission testing involved?

thank you!

[LessValuableNinja]

1. Are consents completed prior to surgery day and by whom? Generally, yes. By provider and MPOA. Usually occurs on the floor before surgery, or during the preop assessment.

2. Are anesthesia consents obtained prior to surgical day and how is this done? Same.

3. Is preadmission testing involved? Depends if it's day surgery and the procedure, or admission has/will occur. Generally yes, though often it's preop rather than preadmission, if they're admitted to the floor first.

I someone is unable to sign for themselves, the discussion should occur about the process during the scheduling or discussions about the surgery. IOW, the MPOA should be involved in those discussions.

[Rose_Queen, BSN, MSN, RN]

We always require a way to teach whoever is authorized to sign consents- whether a patient is scheduled or not. If something happens in the middle of the night, who gets called? There has to be someone. For many of our patients, that means someone has gotten the personal number of the one who signs consents. We don't just call an office.

[RainMom]

9x out of 10, those pts are also DNR which require an additional conversation with the surgeon as to whether the DNR will be suspended for surgery or remain in effect throughout. At that time we get a phone consent where the POA confirms with 2 RNs who sign the form along with the MD.

[Chilly_hands]

I suppose I am not specific enough.

At my hospital, preadmission testing calls patients for phone assmt. Then pt comes for labs, etc. surgical consents are signed in provider office or day of surgery. Anes. Consent is signed day of surgery. Hippa release and conditions of admission and consent to bill insurance all done day of surgery.

sometimes we have mentally challenged pts come from group homes and have no family, just group home workerswho cannot sign consent. These pts are ward of state and some official, ex: judge, county something or other, is the one to sign consent.

how are these cases handled for consents? By phone and fax? The dilemma is 745 first cases and anesthesia and the hippa, insurance billing consent and hippa consent. These court offices are not open atthat time. This is for scheduled cases, not emergent, like lithotripsy, for example.

[Rose_Queen, BSN, MSN, RN]

I suppose I am not specific enough.

At my hospital, preadmission testing calls patients for phone assmt. Then pt comes for labs, etc. surgical consents are signed in provider office or day of surgery. Anes. Consent is signed day of surgery. Hippa release and conditions of admission and consent to bill insurance all done day of surgery.

sometimes we have mentally challenged pts come from group homes and have no family, just group home workerswho cannot sign consent. These pts are ward of state and some official, ex: judge, county something or other, is the one to sign consent.

how are these cases handled for consents? By phone and fax? The dilemma is 745 first cases and anesthesia and the hippa, insurance billing consent and hippa consent. These court offices are not open atthat time. This is for scheduled cases, not emergent, like lithotripsy, for example.

These cases are handled in my facility as I posted above: we must have a number where someone can be reached 24/7. Whether it's whoever is on call for the agency/legally appointed person or a designated person for that patient, we must have a number to reach an authorized person. We will often do phone consent.

[meanmaryjean, DNP, RN]

Also: It's HIPAA

[brownbook]

I don't understand why anyone, from the surgeon, the OR scheduler, whomever does the pre-admission calling, who ever runs the group home, etc., doesn't think or know waaaaay ahead of time that a person from a group home is going to have scheduled surgery and someone with legal authority will need to authorize/sign their consent for anesthesia and surgery?

I know these things happen, but there is no reason for it to be a frequent occurrence.

Cancel a few surgeries due to no one having authority to sign the consent, make a few incident reports, and maybe someone will get the hint.

[Chilly_hands]

We do have phone numbers, etc., but I am asking, does your facility have all this done prior to day of surgery and what department handles this? Ours has the surgeon consent, done through surgeon office. Then there is anesthesia consent (anes must explain what type of anes is given based on health assmt.) and the few other consents the admitting nurse takes care of. I am trying to come up with a plan to have this all done prior to day of surgery vs having to do this minutes before the scheduled time. Anesthesia is no where near our preadmission area so it has been left to be done on day of surgery.

some cases have been cancelled and rescheduled. I am trying to form a plan to avoid these circumstances. I would like this to be a coordinated effort by our PAT department and surgeon office to avoid these pitfalls. I am aware of the issues, I am just looking for anothers process.

[Chilly_hands]

So, anesthesia comes to PAT dept? We are outpatient.

[Rose_Queen, BSN, MSN, RN]

Anesthesia consent is done day of because we don't know which anesthesia provider will be assigned to the case until the morning. It is done over the phone if no one is present in person. Our anesthesia consents are only valid for 24 hours. Surgical consents are valid for 90 days.

[momathoner09, BSN, MSN, APRN]

For an outpatient in our facility (hospital) - ideally- they would go to pre-testing. Surgical consent would be obtained at this time.

More often that not, outpatients will not pretest and then it is our job (pre-op) to obtain surgical consent, blood consent, anesthesia consent (although this is covered in the surgical consent), labs, etc as soon as the patients arrives. Registration will cover HIPPA and "general consent."

The first thing I check for in a mentally compromised patient would be a driver. They will usually be able to be the one who gave consent (relative) or explain to us who did give consent. We did have a situation with a group home resident in which we had to obtain telephone consent from a relative prior to the procedure.

The days I work, I make sure that 0700 cases are taken care of for the next day. You are correct, that is difficult to deal with first thing in the morning. Honestly, the most trouble I have with consents is inpatients that get added on. Floor nurses let them sign consents that they should't or don't get consent, etc.

I wouldn't think this should be a problem with scheduled cases. Charts should be obtained prior and consents checked at this time.

All that being said, I do not let a patient go to surgery with a consent that they signed if they are not competent at the time. That's actually a question I have started asking the floors because of so many issues we have had. Often times consent may be obtained by different nurses and then not checked or updated if a patient's condition changes after surgical orders were written.