consent for surgery - who's job is it - page 2
This last weekend a co-worker (a nurse not even off orientation for maybe 2 months) mentioned that she had been written up by a PACU nurse for writing CABG instead of coronary artery bypass graft on... Read More
Dec 5, '07Joined: Apr '07; Posts: 54; Likes: 78The idea that a physician can place an order in a chart for a nurse to get a consent has always bothered me. Sometimes the doctor will have come in and talked to the patient, other times he(she) expects the consent to be signed prior to them even seeing the patient in the hospital! The hospital I work at competes very closely with another in town, the physicians and surgeons, know this and play one against the other, with a spineless CEO at this one the nurses are expected to get the consent. I never want to get an informed consent unless I heard the doc talk to the patient myself, something that rarley happens.
What I do is ask the patient if they have any questions please address them to the physician, and do not sign the consent until and unless all of their questions have been answered to thier satisfaction. I will then place a stickly note on the consent if the patient doesn't sign, explaining that the paitent wishes to speak to the doctor before signing.
I run about 50% of the patients wanting more information and/or assurances from thier doc before they agree. I know I have developed a reputation of not getting a consent, (i.e. not bending over), but, I really don't care.
Dec 5, '07Occupation: playing science Specialty: NICU ; Joined: Feb '05; Posts: 3,131; Likes: 1,042I'm just saying that as Suzanne pointed out upthread, if a patient decides to sue later on, they can say "I didn't understand what CABG meant". So by writing up the nurse, the hospital covers itself. I'm not saying it's RIGHT, just that that could very well be the reason. Documentation of corrective action taken, so if the nurse does it again and there are legal ramifications, the hospital is less liable.
Dec 5, '07Occupation: Corrections,pre-op Specialty: 12 year(s) of experience in corrections, LTC, pre-op ; Joined: Aug '06; Posts: 80; Likes: 26Quote from suzanne4Right on. I work in pre-op and your on the money with the consent stuff.Abbreviations on a consent are a no-no in any form. And that has nothing to do with who obtained the consent. The consent must be written out including the full words right or left as well as procedures that we usually abbreviations for. Patients may not know them and you want to posibility of them coming back and saying that they did not understand what the initials were for.
The nurse is never the one obtaining consent, having a patient sign after they have spoken with their provider is not the same as obtaining consent; you are only witnessing their signature.
And you will see some nurses sign that right on the consent form, that they were witnesses to the signing of the patient's name only, and nothing more.
Larry RN in Fl
Dec 12, '07Specialty: OB, HH, ADMIN, IC, ED, QI ; From: US ; Joined: Jun '06; Posts: 2,340; Likes: 2,045Quote from MIRockstarRNIf you're written up for not getting the patients' consent, call in the American Nurses' Association (if that's where you live and work). If you have a union, get them in on it. You're not the one doing the procedure, the doctor is!This last weekend a co-worker (a nurse not even off orientation for maybe 2 months) mentioned that she had been written up by a PACU nurse for writing CABG instead of coronary artery bypass graft on the consent. I was telling my mom about this who is also an RN and she brought up a good point - why isn't the physician getting the consent signed. What do they do where you work? We are ALWAYS the ones that get consent where i work, often times without the physician or anesthesia talking with the patients first. I always ask my pt's if they would like to wait till they are talked to by the doc but then I feel like i run the risk of getting written up for not getting consent. What do you think???
Things may have gotten skewed, when patients indicated that they hadn't a clue about what the procedure they were about to have, was. Since patient education has been our responsibility, we filled the gap without even a thank you from the doc - who was only to happy to turn over that responsibility to us.
However, when malpractise insurance companies became more involved in lawsuit prevention, the ball of getting consent went back in the doctors' "court" (pun intended).
I remember my doctor writing a special consent full of dire possibilities I could have as a result of breast cancer surgery, because he discovered that my husband was an attorney! An oncologist giving me chemotherapy also got a very detailed consent signed, and 2 miserable years afterward, said he never would have given me chemo if my husband hadn't been an attorney (that was in the mid '70s, before the current "triple agent" chemo was discovered as effective in Italy). Nevertheless, another primary malignancy in my other breast occurred in '78.
I'm still alive and active in preserving patient rights, which aren't upheld by HIPPAA (which actually contains a clause in which consent is allowed for patient information to be given to "government agencies", any insurance company, and employers). It's a wonder that it doesn't effect their FICO score - yet! :angryfire
Dec 15, '07Joined: Dec '02; Posts: 2,992; Likes: 9,757I was just in the GI doc's office for pre-procedure visit--routine colonoscopy to be done outpatient at a clinic.I assumed I would see the MD at this visit, but I was only intervewed by an LPN(that's what it said on her name tag, she didn't tell me her credentials). She went over the risks and then asked me to sign the consent!!
I know there are different rules outside of the hospital, like a doctor's employee can act under the the doc's license, but does that carry over to informed consent? None of the references I can find state that the doc must obtain consent in person, so I am guessing that he can delegate this as well?
I have e-mailed the licensing board, but has anyone else seen this?
Dec 16, '07Joined: Nov '07; Posts: 518; Likes: 1,360Quote from nursej22Here's what the AMA says (http://www.ama-assn.org/ama/pub/category/4608.html):I know there are different rules outside of the hospital, like a doctor's employee can act under the the doc's license, but does that carry over to informed consent? None of the references I can find state that the doc must obtain consent in person, so I am guessing that he can delegate this as well?
"Informed consent is more than simply getting a patient to sign a written consent form. It is a process of communication between a patient and physician that results in the patient's authorization or agreement to undergo a specific medical intervention.
In the communications process, you, as the physician providing or performing the treatment and/or procedure (not a delegated representative), should disclose and discuss with your patient:
- The patient's diagnosis, if known;
- The nature and purpose of a proposed treatment or procedure;
- The risks and benefits of a proposed treatment or procedure;
- Alternatives (regardless of their cost or the extent to which the treatment options are covered by health insurance);
- The risks and benefits of the alternative treatment or procedure; and
- The risks and benefits of not receiving or undergoing a treatment or procedure.
In turn, your patient should have an opportunity to ask questions to elicit a better understanding of the treatment or procedure, so that he or she can make an informed decision to proceed or to refuse a particular course of medical intervention."
Dec 17, '07Specialty: med/surg, telemetry, IV therapy, mgmt ; Joined: May '05; Posts: 15,027; Likes: 8,985Quote from MIRockstarRNWasn't this discussed with you at your orientation to the hospital when you were hired? We are merely witnessing the patient's signature on the consent form. Yes, we are to ask the patient if the doctor has talked with them and if they have any questions. If they do, then we are obligated to inform the doctor. Talk with your facility instructor or whoever conducts orientation classes to clarify this for you.why isn't the physician getting the consent signed. What do they do where you work? We are ALWAYS the ones that get consent where i work, often times without the physician or anesthesia talking with the patients first. I always ask my pt's if they would like to wait till they are talked to by the doc but then I feel like i run the risk of getting written up for not getting consent. What do you think???
Dec 25, '07Joined: Jul '07; Posts: 636; Likes: 124Everything about the procedure or surgery should be explained by the doctor and the patient has all the right to refuse or undergo the surgery. We serve as a witness to the signing of consent or sometimes we give them the consent form after the doctor has explained everything to the patient with the complete name of the procedure (no abbreviation please!). Simple as that!
Dec 25, '07Joined: Aug '04; Posts: 9,279; Likes: 4,304I wonder if docs don't get that their patients can be in such a state of fear and denial about a surgery, that they don't "get it" when the doc does the consent process?
A surgeon actually tried to ream me a new one the other day because the patient hadn't been brought to surgery.
I told him that I assumed that he was going to come up and speak to the patient about the surgery and get consent. He insisted he had. I actually walked into the room and asked the patient again and held the phone so he could hear the answer, "No, I haven't talked to the doctor about the operation."
Amazing how the mind works, isn't it.
I believe the doc because I've seen this happen when nurses do teaching about things with patients, but unfortunately, I didn't feel comfortable witnessing that patient's signature for the surgery.
Docs would actually speed the process for procedures by getting that signature at the same time they write the order, IMO.
Dec 25, '07Specialty: OB, HH, ADMIN, IC, ED, QI ; From: US ; Joined: Jun '06; Posts: 2,340; Likes: 2,045Many decades ago, it was the nurses' responsibility. When the need for "informed" consent became apparent, it became the doctors' duty to explain the process, (which of course should be translated into understandable form in typewritten form), and after that explanation the questions the patients ask should be written, with the answers given. Hand held computers make that possible now, and the questions reveal what the patient understands, like "what did you say?"
The insurance companies made it necessary for the doctor to explain what was about to be done, but nothing is said, still, about the anticipated expense above that covered by insurance. Since poverty is a life changing event, I think the amount the patient needs to pay should be part of "informed" consent. If time is not of the essence, (as some elective procedures are not,unless the doc wants that Ferrrari NOW),it may be prudent for the patient to refinance their homes before the deed is done, or for their significant other to hang on to that job with benefits....... What do you-all think?:spin:
The spontaneous, handwritten consents I had to sign for breast biopsies were very frightening, (due to my ex-husband's vocation - an attorney) indicating that death was definitely a strong possibility during surgery, and that was especially hard to take - after hearing that, I heard no more.
Nothing was written about the small metal things that would be left in bilaterally after my mastectomies (4 years apart, by different surgeons), and which I just saw on my chest x-ray. That is disturbing, but the "statute of limitations" has run. They weren't staples, so what could they be?
Mar 13, '08Occupation: Registered Nurse Specialty: 5 year(s) of experience in ICU ; Joined: Mar '08; Posts: 54; Likes: 21On our floor, we only get the consent if we know the doctor has talked to the patient about the surgery. We ask the patient if they have any questions, if they do we won't get the consent signed, until the MD has came and talked to them again.
A lot of the Anesthesiologist (sp?) get ****** at us for not getting their consents signed. They will even call to the floor the night before telling us, to but we won't.