informed consent

Nurses Safety

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Specializes in critical care.

The way I understand it an informed consent is when the MD explains the risks/ benefits of an invasive procedure to the pt/ representative and the nurse's only legal obligation is to witness that the pt consents to the procedure. I dutifully carry out the order "obtain consent for such and such" of probably 90% of the procedures done on my pts. Will this bite me if there's a lawsuit about a procedure I signed the consent when legally speaking there was no consent? Should I go to the administration about this?

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The nurse's legal obligation is to make sure the patient SIGNS the consent: that is, match the name on the arm band to the name signed, to verify identity, then the nurse signs as a witness to the signature.(kind of like a notary). The nurse is NOT obtaining consent, nor is she a witness to anything the surgeon told the patient to inform him.

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Specializes in PICU, Sedation/Radiology, PACU.

As a nurse, you are not legally allowed to obtain consent. You are allowed to witness that the patient signed the consent form. That's all. You cannot explain the risks and benefits of the procedure, but you can reinforce what has been said.

So to answer your question, yes. If there were a lawsuit and the patient said "The doctor never explain the procedure to me. Nurse X did." You would definately be held liable for practicing outside your scope of practice.

The solution is to stop obtaining consent. I've been asked to do so by various physicians a few times, and I have politely refused. I've said, "I'm sorry, I'm not allowed to do that. I'd be happy to witness the consent for you, but you need to come and speak to the patient." If the physician/anesthesiologist/etc, gets upset, then escalate to your management.

If you're doing this, other nurses on your floor are probably doing it as well. It might be a good idea to inform your manager that doctors are requesting this so that everyone on the floor can be educated.

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Specializes in critical care.

Every nurse on the unit performs "consents". Never heard of any nurse declining to do one. My first career was in research so I know a study would be shut down and litigated without a legal consent. Status quo and peer pressure... Will bring this up to my clinical leader. Thanks.

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Specializes in DOU.

Our consent forms say something to the effect that "Dr. So-and-so has explained the risks, benefits, and alternatives", so as far as I can tell, I am only witnessing the patient's signing.

One thing I won't do is have the patient sign consent forms for anesthesiology, because I have never in my life seen an anesthesiologist come to my floor - Never - so I know very well that it hasn't been discussed.

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Specializes in Family Medicine.

How about for a TEE? The MD had not explained the TEE to the patient and all the nurses on the floor said I should do it, "just print out some information and explain it to the patient." I understand it's not surgery but since a consent form is required I did not feel comfortable explaining the test.

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The consent information must, legally (per the CMS federal regulations) be discussed with the client by the individual who will be performing the procedure. The RN is not obtaining consent, only witnessing the signature on the form after the physician (or whomever) has reviewed all the information with the client. In my own practice, I've always asked a few questions to verify to my own satisfaction that the physician (or whomever) actually did discuss the procedure with the client and the client understands at least the basics of what was discussed before I am willing to witness the signature.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Most facilities have changed policies that exclude nurses from obtaining signatures on consent forms for procedures because it is the MD's responsibility to perform the informed consent. However there are facilities that aloow nurses obtain signatures on consent the witness the patient's signature and nothing else. You need to check with you facilities policy/procedure manuals and risk maqnagement people as well as your states nursing board to ensure thsi is what is going on and that you can legally perform. The facilities that I have worked for must have the MD signature on the consent that he gave the patient informed consent before any other signatures are added.

The order should read.... obtain signature on consent form for xyz. BUt if the MD is explaining the procedure to the patient and should sign the consent himself.....why are you obtaining the consent? you need ot look into this..

http://www.ama-assn.org/ama/pub/physician-resources/legal-topics/patient-physician-relationship-topics/informed-consent.page

http://en.wikipedia.org/wiki/Informed_consent

http://misc.medscape.com/pi/sites/infosite/riskmanagement/28ArticleInformedConsentMorethanPaper.pdf

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Specializes in critical care.

Every nurse on our unit explains perc trachs, central lines, bronchs, chest tubes, laproscopy, anasthesia, major surgeries, etc,etc because I'm often witnessing for their telephone consents. two weeks ago I was in a position to explain a swan-ganz catheter. Thanks, I'm never doing this again.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Every nurse on our unit explains perc trax, central lines, bronchus, chest tubes, laparoscopy, anesthesia, major surgeries, etc,etc because I'm often witnessing for their telephone consents. two weeks ago I was in a position to explain a swan-ganz catheter. Thanks, I'm never doing this again.

While it's ok to go back over what the MD said you should not be the one explaining the complications,indications and procedure unless the MD does so first. Make sure you aren't putting yourself in a bad position.

To simply explain a Swan...."It's a special IV that goes into your neck and partially into the right side of your heart (the safe side of your heart -wink)that tells us important information like how hard you heart is or is not working and how much fluid you may or may not need and what medicines to give you and change...it helps us really focus on whats important to make you better quicker and specialize it just for you.(smile)".

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Specializes in family practice.

If i was told to get the consent, (My first thought is the physician has explained the procedure), i go into the pt's room and ask if the pt has explained, if he says yes and repeats what was told, if it sounds right then ok if it doesnt, i might further ask, do you understand what would be done with the risks and do you agree, if they say no they dont understand, id call the physcian to reexplain. But for the most part the nurses do not get consents at out place except in the OR and thats after seeing the physician talking to the pt.

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This whole issue of "informed" consent has been a bit of a bug for me for many years. One of our heart surgeons used to document that the risks and benefits of the surgery had been thoroughly explained to the patient. Now this was heart surgery - about as big a deal is it gets. I'd heard him do that "thorough explanation" many times and it went like this: "Your cardiologist has referred you for bypass surgery. It's a big operation, there is some risk, but we think it's the best thing for you."

Yup - thoroughly explained. I was the patient educator who would actually explain to patients what was going to happen. But I always bounced questions about risk and alternatives back to the doctors.

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