Obtaining/verifying consent

[Gampopa]

Hi all...I'm getting ready to take NCLEX in late Sept and have a question. Who is responsible for obtaining consent to procedures? In some places I've read it is the nurse's responsibility and in others the physician or surgeon is legally responsible. In other places I've read that it's the physicians or surgeon's responsibility but the nurse must verify that consent has been obtained. Anyone have any input?

[suzanne4, RN]

It is always the responsibility of who will be doing the procedure to obtain the consent. If for surgery, then the surgeon. It is never, ever the responsibility for the nurse to obtain consent...........they are witnesses only to the signature on the consent, and should have nothing else to do with the consent. The nurse should follow up with the patient to make sure that they understand everything, this is something different.

[zacarias, ASN, RN]

Suzanne,

What I don't like about most facilities that I've worked at is that they have the nurse present the consent form to the patient after the doc has ordered the procedure. Then the nurse witnesses when the patient signs.

Apparently this is standard practice but I don't like it because you ASSUME that the doc has indeed provided thorough information of the procedure to be informed including risks and alternatives. I have addressed this at two hospitals and no one seems to find this odd.

What I think should happen is that the doc explaining the procedure should get the consent form him/herself and write something on it (or ever get the patient's signature)to show that he/she has indeed been there to explain the procedure to the patient.

[suzanne4, RN]

Most of the consents that I have seen now, explicitly state that the patient has received full information about the procedure from their physician and the patient has to actualy sign the consent form as well.

[pricklypear]

Suzanne,

What I don't like about most facilities that I've worked at is that they have the nurse present the consent form to the patient after the doc has ordered the procedure. Then the nurse witnesses when the patient signs.

Apparently this is standard practice but I don't like it because you ASSUME that the doc has indeed provided thorough information of the procedure to be informed including risks and alternatives. I have addressed this at two hospitals and no one seems to find this odd.

I've worked at 2 hospitals, and this is how it is done at both. I always ask the patient if the doctor explained the procedure/test. And if they have any further questions. If "yes" and "no" I have them sign it.

I used to always assume that the doctor did his/her legal duty by discussing procedures with the patient, but I found out otherwise one evening. I had an order from the previous shift to sign consent for CAGB in the am. When I asked the patient if the doctor had explained things adequately, I was told "No, I've never met the doctor who's going to operate on me - I've been waiting for him all day." I was shocked. I asked if he saw the PA, "No." It seems this surgeon came through the unit, examined the CHART, left orders, and left the building.

So there I am on the phone, "I'm sorry, I cannot have the patient sign the consent until you talk to him." "AGGGAAGAGGA" "I understand, but I can't do it." So they ended up having a telephone conversation, and I witnessed the consent. Luckily, that's the one and only time that sort of thing has ever happened.

[aegirl]

I just covered this yesterday in lecture and my instructor said that we are only witnesses to the signature. He also said that next to witness he always puts "signature only".

[JentheRN05, RN]

Nurses only witness and most importantly verify that it's on the chart prior to a procedure.

[mshultz]

Suzanne,

What I don't like about most facilities that I've worked at is that they have the nurse present the consent form to the patient after the doc has ordered the procedure. Then the nurse witnesses when the patient signs.

Apparently this is standard practice but I don't like it because you ASSUME that the doc has indeed provided thorough information of the procedure to be informed including risks and alternatives. I have addressed this at two hospitals and no one seems to find this odd.

This was my experience as a patient for the 3 consents that I signed. The doctors NEVER provided informed consent, and the nurses just said "I need you to read and sign this" without asking whether I understood the informed consent process. It was never explained to me that the nurses were witnessing my signature. As a result, I felt pressured to read and sign as quickly as possible. Nothing on the form gave any instructions as to who was supposed to give informed consent, or what to do if it was not provided.

What I think should happen is that the doc explaining the procedure should get the consent form him/herself and write something on it (or ever get the patient's signature)to show that he/she has indeed been there to explain the procedure to the patient.

I agree completely. I eventually requested my hospital records, which allowed me to review the consents I had signed, and also see the forms that the nurses filled out where they signed that they had witnessed my signature. Thanks to allnurses.com, I now have a thorough understanding of the informed consent process.

I came across a comment on the web from a doctor who stated they only provide informed consent if the patient specifically requests it. Based upon my own experience, I have to assume this is the norm. In the future, I will state that I want detailed, comprehensive, written information addressing all aspects of benefits, risks, and alternatives prior to the date of the procedure, so that I have time to study the information, do additional research, and ask questions.

[limabean]

We recently went through a JCAHO inspection at our hospital, and I learned some interesting things I did not know. They require that the doctors document in the progress notes or on the consultation sheet that the patient has been informed of the risks, benefits, etc of the procedure. What I had previously been doing (and what I had been taught to do) was to go in to the patients room and ask them if the doctor explained the procedure and the risks, benefits of it. If they said yes then I would ask them to explain it to me. If they said no, I would call the doctor and make them aware that the patient needed to be informed about the procedure. However, I never checked the progress notes or consultation to make sure it was documented before going ahead with the procedure. According to JCAHO if it was not documented by the physician --- then the patient did not receive informed consent. This makes sense b/c we've all been taught "If it wasn't documented then it was not done." But I really wonder how many people actually practice this process? Also I would like to hear from others if they have any facts on the legalities of actually performing a procedure without the physician documenting that it was explained. Also, JCAHO said that the consent form is not considered informed consent even though it does say that the risks, benefits, etc have been explained.

[zacarias, ASN, RN]

Good replies.

Limabean,

Thanks for that info about JCAHO, it makes sense. I ask patients always if they've received info from the doctor and know of the risks. No matter what they say sometimes I still wonder. However, if the doc charts that the procedure was explained, my worry in this regard will be eliminated.