Order for a consent

[kanashe]

i work in mostly an outpatient area. it's always the same group of physicians that do the procedures. my question is, do you need an separate order to obtain a surgical consent if you already have an order for the procedure.

for example, the patient comes in with an order for a "right lung biopsy". do i need an order stating obtain consent for "biopsy of right lung" by "dr. smith". or does the order for the procedure suffice?

i can certainly understand if the procedure was a hyst why you would need a separate order, because the surgery could involve taking out or leaving in the ovaries and other organs. but just for a straight forward procedure, i 'm unsure of why a separate order would be needed.

thanks as always for all of your expert input.

beth

[CaLLaCoDe, BSN, RN]

MD is responsible to describe the procedure and obtain the consent.

[BluegrassRN]

Where I work, an order for the procedure means that you can witness the consent. For example, if I see an order in the chart for bronchoscopy with possible bx, I will fill in the consent form, and ask the patient if the physician has discussed the procedure and if so, if they have any questions. If they are generic questions (will I come back to this room afterwards?) sort of questions, I will answer them and witness the consent. If they are more specific to the procedure, or if the patient is unsure if they want to have the procedure, I will defer the witnessing of the consent for the physician.

Most of our our sets contain the consent. So, if the doc writes an order for L heart cath, entering that into the computer generates an order set that prints up, and it includes the preprinted consent. All we then have to do is witness the signature, all the other info is already filled in.

[Virgo_RN, BSN, RN]

Any invasive procedure needs a consent, and no, you don't need an order.

[RunningRNBSN]

The hospital I work at as a specific policy that states a physician is required to write an order for the consent (if it is a surgical procedure). For example, if a patient of mine is scheduled to have an Exploratory Laparotomy -- the physician cannot just speak to the patient about it and then have the nurse do a consent. They have to write a physical MD order stating "Obtain consent for exploratory laparotomy by Dr. Smith & Residents".

This is supposed to be true for invasive procedures as well (Inserting A-line or CVL) but orders for these types of procedures are rarely written.

[Patricia Emery]

I've always believed that physicians should obtain their own consents, but in my practice, they have rarely done so. I would not, however obtain a consent without an order.

BTW, I dislike the term "order" I like to call them prescriptions. I am sure, however, that I will not have my way about that, at least not in this lifetime.

[emoening]

I don't know how it's "supposed" to be done, but on my floor, us nurses obtain the consent 99% of the time. There is 1 surgeon who actually signs the consent and fills in the blanks so the nurse just has to get the pt. to sign and then the nurse witnesses. But other than him, every other surgeon in the hospital does not do his own consents. Like someone else had said, when the pt. is put into the computer for a procedure, an OR packet prints out (including a consent form). Then we nurses fill in the blanks (MD's name, pt's name, procedure) then get the pt. to sign, then we sign as witness.

Now that I'm actually sitting down to think about...we probably shouldn't do that. It really IS the MD's responsibility to get the consent, but I think it's one of those things that "should" happen in a perfect world, but never would in the real world.

[Jokerhill]

The MD gives the R&B's obtaining consent at the time he talks to them. Then I go in later without the MD to have them sign the form. This way they have a few minutes to think with out the MD there to pressure them. The MD is a salesman in this position so I want to ask them without him there allowing them to ask further questions if they have any. If the have further questions about the proceedure itself I get the MD back in to talk to them first before I have them sign the form. They normally don't have questions, but I give them the chance.

[diane227, LPN, RN]

It is the physicians responsibility to get the consent. When they give us that order we print out the correct form, fill in the physician name and check the procedure according to his order (consent for colonscopy) and put it on the front of the chart. If I know he has spoken with the patient about the procedure and the patient is aware of what they are having, I will have the patient sign the consent and I will sign as the witness. If the physician has not spoken with the patient, I will not sign or have the patient sign until they have done so.

[cherrybreeze, ADN, RN]

We need orders for consents. Some docs will order a consent without having seen the patient (for a chole, for example). If they haven't talked to the patient, I won't get it, if they have, I will. Sometimes what they are calling the surgery isn't as specific as what needs to go on the consent (ie, exploratory lap vs "exploratory laparotomy, possible small bowel resection, possible ostomy, bilateral ureteral stent placement") so I wait to see that order. No point in having to get two.