Informed Consent Dilema!

[ecat81]

In the ED we have patients that undergo procedures in the ED and of course many that go to surgery. Many times the patients going to surgery do not see the physician until they arrive in pre-op. Surgery always complains that the ED didn't get the consent signed:angryfire. I never get the patient to sign the consent unless its informed consent. (Emergency surgeries are different of course-then you dont need a consent) I was reading an article and came across something that I hope to get some feedback:yeah:.

Informed consent is an agreement by a client to accept a course of treatment or a procedure after complete information including the risks and facts have been presented by the physician.

The nurse is just a witness to the giving of informed consent.

Then, the (of course) nurse gets the consent signed by the patient after the following has been met:

1. The consent is voluntary

2. Consent must be given by an individual with the capacity and competency to understand.

3. The patient must be given enough information to be the sole decision maker.

BUT:D...also in this article it states if the nurse only witnesses the client's signature and not the exchange of informed consent between the patient and physician then the nurse shoud write "witnessing signature only" beside their signature.

My question is by writing "witnessing signature only" and documenting in the nurses notes does this cover the nurse legally? Also, can this been done without the patient actually having informed consent? In other words the paper is signed and the nurse "witnessed signature only" be used legally?

Thanks!

:twocents:My opinion still stands that I will not get it signed myself and will back any of my nurses that don't have the consent signed before surgery, without the patient being informed.

[Dolce, RN]

I work in pre-op and am never upset that another nurse didn't get the consent signed if the patient hasn't spoken with the doc. Informed consent is a process between the physician and patient. It is not just a piece of paperwork that needs filled out. When I have a patient sign consent I always confirm the procedure with them and ask them this was what their physician explained to them. I also ask if they have any questions for their physician prior to signing. If they agree and have no further questions then I have them sign and witness their signature. It is very inappropriate for the pre-op nurses at your hospital to pressure you to have the patient sign consent prior to speaking with the physician. Consent is not your responsibility ultimately, its the surgeon's.

[Erin 321]

Obtaining informed consent is the responsibility of the person performing the procedure (in this case, the surgeon). You truly are just witnessing a signature when you ask someone to sign a consent form. It's a tool, but if it ever went to court, you would not be held responsible for ensuring the patient was informed about the procedure prior to having it done, whether or not you wrote 'witnessed signature only' by your name. That being said, I never ask patients to sign a consent form for surgery. I do it all the time for CT scans and stuff like that but surgery is too big and I think it's a good reminder for the surgeon to be sure to have a discussion with the patient if the consent form is left unsigned. Our surgeons usually take on the responsibility themselves, and get the consent form signed in the ED. If not, I ship the patients off to the OR without it, clearly indicate on the pre-op checklist that the consent form has not been signed, and have never been given grief about it once. Who in their right mind would want to be asked to sign an informed consent form if they haven't even seen their surgeon yet?

[northshore08]

When I witness a consent of any kind (OR procedure, blood transfusion, ED procedure, etc.) I am only witnessing that the patient signed the form. I am not witnessing that they discussed it with the doc. I do ask them if they have any questions and will help get the doc or the answers they need, but my name on that form states that I witnessed the pt signing the form. (That is how the doc can come out of the room after explaining and ask me to get it signed.)

[mmutk, BSN, RN, EMT-I]

I understand where you are comming from here, I used to get consents signed with or without the MD. But these days I never consent a patient for surgery unless they have spoken with in person the MD that will operate on them.

My only exception to that is a STEMI going to the cath lab from the ER. I will explain those risks and the urgency of the procedure and consent them if needed.

Otherwise no doc at bedside, no consent. Screw anyone who hates on me for that.

[rjflyn, ASN, RN]

I explain that situation to my nurses like this. The piece of paper is a formality. Informed consent can be and is obtained without it. The paper is just documenting it, AND consent is not complete until the patient and doctor have spoken to one another and agree to whatever procedure or surgery. ALSO the physician has to document in his H&P that he obtained informed consent. AND as others have stated you are just a witness to a signature not to any of the above.

Rj

[mshultz]

I am not a healthcare worker, but I was a patient in the ICU and ED back in 2003. I signed 3 consents, EGD and blood transfusion in the hospital, and a colonoscopy consent as an outpatient.

I was not provided with informed consent, a description of the procedures, or even met with the physicians prior to the procedures. I signed because I was told to sign, and did not know any better.

One of the many papers I wrote for Gerontology class was a class critique. I commented that whenever I wrote a paper, I was struck by the trivial effort the research required, compared to the 2 years of sheer hard work it took for me to understand the informed consent process. I called my experiences with informed consent a breach of trust.

After I requested my medical records, I saw that the doctor had signed a form saying he had discussed the risks of a colonoscopy with me, including the risk of perforation. There was no such discussion, nor was I provided with written consent information for this or the other 2 procedures. The consents themselves were blank consents, with no discussion of risks, benefits, and alternatives.

I am convinced that when the doctors are not required to get their own consents, communication becomes impossible. Nurses should not be involved in the consent process unless they actually are present when the information is discussed with the patient.