Consents

[ChicagolandRN]

Just wondering how other hospitals handle getting consent. I was taught in nursing school that it's the physician's responsibility to explain the procedure and obtain a signature, and the nurse's responsibility is to sign as a witness, meaning that the nurse believes that the patient (or legal representative) has a sufficient understanding of the risks and benefits of the procedure.

I have, however, been to several hospitals where the doctor tells the nurse to "get consent", sometimes without even telling the patient what he or she has planned!

This has been bugging me for some time. How does everyone else handle this?

[mcg02]

I have this happen all the time on my floor as well. Sometimes the MD writes and order to have pt sign consent form and I will go in there and ask if the MD has talked AND explained the procedure or test, if yes I sign on no I do not sign. Most of the time I just wait till the patient goes down for the procedure and have them sign like in special procedures or DTC etc, that way it is no longer on me.

[Tweety, BSN, RN]

It is the MD's job to talk to the patient before consents are signed.

Never get a consent where the patient isn't informed by the physican.

At our facility the MD doesn't actually have to get the signature on the consent, heaven forbid while they speak to the patient they fill out a consent and have the patient sign it. We can get the signatures, if and only if, the patient has been informed by the MD.

I always ask the patient have they been informed by the MD about whatever, if not, then I don't get the signature. Never.

[unknown99, BSN, RN]

Ditto, thirdshiftguy!!!

[bellehill, RN]

Ditto thirdshiftguy and sagarcia210. Wouldn't it be great if they just took the stupid form in with them while explaining the procedure? I have even clipped one to the front of the chart completely filled out and still they didn't use it.

[ktwlpn, LPN]

In my LTC we have had several instances in which surgeons faxed us consents forfamily members to sign-without ever speaking to them-not even over the phone.This happened several times on the dementia unit...I was not comfortable with this as the family always had numerous questions-I got into the habit of notifying the families of the doctors appointments before hand and leading them to believe that they MUST meet their loved one there...Met with a great deal of resistance,too....They always seem to want everything done for "Momma" as long as 1-it is not inconvenient for them and 2-it does not cost them a penny...I was under the impression in acute care that when the nurse signs the consent she is only witnessing the patients signature-not that they have been spoken to by the doc and understand the procedure....

[Agnus]

Legally it is the person doing the procedure that is responsible for informing the patient.

(so if it is a nurse who actually does it then it falls on that nurse)

It is assumed the pt. is fully informed and has had all thier questions answered.

Occasionally they have questions. I refer those questions back to the person responsible for infoming. I don't repeat the question. I just say this person has some questions for you before signing and since you are doing the procedure they want you to answer. This works when the person has no knowledge about the proceedure as well.

I don't get an argument because I use the line since you are doing the procedure they want you to tell them. They GET the message.

I always ask did you have this explained, do you understand, do you have any further questions and do you consent.

A no to any one of these calls for no signature at this time.

[suzanne4, RN]

But a stranger one is the patient who signs a blank consent for surgery. I used to get several a week at this one hospital and from different nurses. Why would a patient sign a blank one.

One problem with waiting for the consent to be signed in the specialty area is if a pre-op med was ordered. If it was and you give it, you can't obtain a legal consent for a procedure from the patient.

[TiffyRN, BSN, PhD]

I've worked several different hospitals over the years. Used to be it wasn't unusual for something like this to happen: Primary orders consult with GI for heme-positive stools. GI doc calls the floor at 11pm and orders: 1. NPO after midnight, 2. IV access w/KVO fluids, 3. Obtain consent for Upper GI Endoscopy. First time the patient saw the doc was immediately before the procedure.

The last hospital I worked at used to be something like that, sometimes the doc would talk with the patient, sometimes not. Then they (hospital admin) cracked down and insisted that the docs be responsible for explaining the procedure and obtaining consent, nurse was to witness only (doc didn't have to be present but nurse had to verify those things had been done). Well, that's the way it was supposed to be all along wasn't it? Really hacked off a couple of OR nurses when they would call to pre-op a patient first thing in the morning and we would have to tell them that Hey, patient can't/won't sign the consent till Dr. Dufus comes and explains what he wants to do.

Since they started doing that we saw great improvements in compliance, even had docs finding the consents and taking them to the rooms asking a nurse to accompany them so we could witness while they went through the consent with the patient.

This hospital had it's drawbacks but one of it's strengths is that it was very pro-nurse. Docs had to take a lot more responsibility for themselves and Lord help them if they were nasty to us in person or on the phone. It happened, but not usually more than once.