didnt get consent signed?

brownbook · Oct 23, 2014

I have no "legal, administrative" idea what will happen. I was in adminstration over 14 years ago so don't keep up with that stuff.

But the pre-op nurse, surgical nurse, anesthesiologists, and even the surgeon. ALL should be, ethically if not legally responsible for the "routine" checking that there is a signed consent prior to the surgery. Not just you!

Will someone "throw you under the bus" and blame you....maybe?

I don't know if the surgeon, you, administrators, can (should) go to the patient after the fact. Profusely apologize for the mistake, and ask them to sign a form, consent, stating something to the effect that a mistake was made, you did not sign the consent prior to surgery but you verbally agreed to the surgery and will sign a consent acknowledging (after the fact) that you agreed to the surgical procedure?

Sorry, I have too much common sense! I know that idea won't fly!

brownbook · Oct 25, 2014

I hope you get a better reply than mine? I am so curious what will happen? Maybe ask the question in the general forum or the specialty OR forum?

Home Health Columnist / Guide · Oct 25, 2014

You may get more response by posting in Operating Room Nursing ....sure they have the best advice for this issue.

MunoRN, RN · Oct 25, 2014

The responsibility of obtaining consent falls to the person performing the procedure, in this case the surgeon. It often falls to nurses to help the surgeon ensure it is complete, but in the end it's the surgeon who's responsible. The doesn't mean Physicians aren't often successful in making nurses more liable for their own mistakes than they are.

Maeve1982 · Oct 25, 2014

Something similar happened to me awhile back: I'd just come on shift and suddenly I was told that one of my sicker pts was going to have to have emergent surgery. The doctor was out talking to the family and told me that they had given consent. Therefore, since the patient was approaching unstable, the main task at hand was to pack him up and get him to the OR. The consent was never signed and I got a note from my manager the next day about it, which I understand. I wasn't written up or anything, but I did feel that it was the doctor who'd gotten the verbal consent as I was nowhere around (busy in the pt's room getting him packed up, getting the meds in order, taking turns bagging, etc) so I think that, technically, I was wrong because it was my patient and my responsibility, but I thought the doctor should have shared the blame as well because he never mentioned it even in passing so I had no clue something was amiss until the next shift.

I felt badly about it, but by that point, I could do nothing and the pt got the much needed procedure done without a hitch.

dudette10, MSN, RN · Oct 29, 2014

Something similar happened to me awhile back: I'd just come on shift and suddenly I was told that one of my sicker pts was going to have to have emergent surgery. The doctor was out talking to the family and told me that they had given consent. Therefore, since the patient was approaching unstable, the main task at hand was to pack him up and get him to the OR. The consent was never signed and I got a note from my manager the next day about it, which I understand. I wasn't written up or anything, but I did feel that it was the doctor who'd gotten the verbal consent as I was nowhere around (busy in the pt's room getting him packed up, getting the meds in order, taking turns bagging, etc) so I think that, technically, I was wrong because it was my patient and my responsibility, but I thought the doctor should have shared the blame as well because he never mentioned it even in passing so I had no clue something was amiss until the next shift.
I felt badly about it, but by that point, I could do nothing and the pt got the much needed procedure done without a hitch.

The pre-op nurse threw you under the bus. That's why you got "a note" about it.

As an aside, there is often tension between floor nurses and procedural areas. The procedural areas are usually under time constraints to get 'em-in, get 'em out, NEXT! I understand that, I feel for 'em, I really do. Sometimes, though, I wish they understood what environment the floor nurses work under, too. Here's a long example of how it gets "dumped on" the floor nurse.

I had a patient scheduled for a TEE. The background on this I'm not usually privy to, but getting background by accident really opened my eyes to some things. The hospitalist in charge of the resident program was "hiding out" in the nurse's mini-station, which they sometimes do to the nurses' chagrin. (Dude, can you freakin' count the number of computers in here?! Now count the number of nurses working this side. Thanks, now leave!) Anyway, I digress.... H

The hospitalist said, to no one in particular, "You have to watch every single thing these residents do! I can't believe they missed that!" He then got on the phone about a TTE early in the patient's stay that showed something questionable, possibly vegetation. The patient was scheduled to be discharged that day, but it would be delayed for a TEE. I didn't even know it was my patient until about five minutes later, an order for a TEE popped up on my screen. You gotta be kiddin' me! This guy was jumping out of his skin to go home, and now... REALLY?!

I had promised to the patient to inquire about the discharge, but now I knew when I walked in that room, I would have to break the bad news. As much as I would love to punt to the residents for their royal screw ups, I try to do that ONLY if I'm unable to appease the patient myself. I'm usually successful, as I was in this case. I explained the process and the purpose, and informed him that risks/benefits/alternatives would be explained by the doc doing the procedure when he got down to the suite. NPO education. Done. He was a nice guy, so he was cool with it.

Almost immediately, I get a call from the cardio station about the TEE. Informed her that I made the patient NPO, but he took his last sip of water with meds about 30 minutes previous. She groaned, said thanks, and hung up. I went to clean up a patient in a Cdiff room. Took about 15 minutes, with my phone going off three times while I'm up to my elbows in poop. Get done, walk out to the NM carrying her phone toward me. Put it up to my ear and barely make my intro when the cardio RN says, "I tried to call you three times!" Told her I was cleaning up a patient. She says, "Well, it is imperative that we get this guy down to the TEE, and it is VITAL that we know when his last substantive intake was. The sips with meds doesn't count. When did he last eat?" I told her I don't know, I would have to ask him. I walk to the room, get the information, and she said she was sending for him immediately.

My eyes were completely opened to the clusterpuck of healthcare and the docs' part in it. The ONLY reason all this was happening was because the residents screwed up, and the ONLY reason I got five calls from two RNs in the space of 30 minutes was because the cardiologist was ticked off that he had to clear his schedule to get this guy's TEE done so the pt could be discharged that day, if possible.

We nurses spend a LOT of time picking each other apart, but if we knew the entire picture, I think we would find that the docs' actions or inactions play a much bigger part in the stress of our jobs than we ever thought possible.

Just something to think about...

BuckyBadgerRN, ASN, RN · Oct 30, 2014

In my state ONLY the MD can get the consent signed. No nurses thrown under the bus where I work!

Techy214 · Nov 24, 2014

Yes I agree that it is the person who is explaining the risks and benefits of the procedure who should obtain the consent. The nurse has a responsibility to chase it if it has been overlooked but there's only so much you can do.

KelRN215, BSN, RN · Nov 28, 2014

When I worked in the hospital, the MD was responsible for obtaining the surgical consent and the Anesthesiologist was responsible for obtaining the Anesthesia consent. It was part of the nurse's responsibility to make sure these were done but we didn't do them.

Techy214 · Nov 28, 2014

It's so much easier for them to blame the nursing staff than actually challenging the Drs in the same way. They would never use the same tone of voice and blaming attitude towards them. That is why we need to document like crazy.

dexm · Dec 1, 2014

When I worked in the hospital, the MD was responsible for obtaining the surgical consent and the Anesthesiologist was responsible for obtaining the Anesthesia consent. It was part of the nurse's responsibility to make sure these were done but we didn't do them.

Agreed. On my unit we frequently assist with bedside procedures or travel to another part of the hospital for a procedure (i.e., interventional radiology, cath lab, etc.). While we aren't responsible for obtaining the consent itself for the various procedures, we are responsible for making sure the consent has been completed and that it has been signed by the appropriate person. Since many of our patients are intubated/sedated or otherwise incapable of being consented, and next of kin situations can get a little hairy, I was always taught to verify that the correct person signed the consent. Always look at the signatures just to be sure. I would think this could potentially be a fireable offense, but it seems more likely that you would get some kind of disciplinary action.