Consents

brownbook · Feb 15, 2015

How does your unit handle consents? What where the stickiest situations you encountered verifying a consent? Can someone on a 5150 sign at your hospital? Foreign languages? Patients on pain medication? What is an RN's legal obligation with regards to consent?

In out patient surgery we only have the written (faxed) history and physical that has the consent to read. We write it on our consent and are technically only witnessing the correct patient signed it. We of course ask the patient what they are having done (in their own words is fine), do they understand, is this what they and their surgeon have discussed, etc. The surgeon makes a brief stop at the bedside before surgery, sometimes says no more than, hi, are you ready, let's go.

A sticky situation was a 90 + year old patient had bad cataracts in both eyes, one worse than the other. The ophthalmologists was going to operating on the "better" left eye. When asked which eye was being operated on the patient kept saying....my right eye, it is the worst. I, the family, the surgeon all agreed the patient was having the left eye done. I, we, could have stopped everything, sent the patient and family home, required a power of attorney, etc.,. Or we could have done his cataract surgery and given this poor man some decent vision in his last few month, years, of life. Which is what we did.

A 5150 is messy, I kind of think it requires a judge, court order if they refuse. However in an emergency, as with anybody, consent is implied to save their life. Honestly it is messy....if the patient is 5150 but readily agrees to surgery, and it is well documented that the surgery was explained, alternatives were explained, etc., then they can sign (I think?)

Foreign language we have to use a certified translator, we have (I forget the exact name) a telephone service that provides translators if we don't have someone certified in that language.

I forget how long we are supposed to wait after pain medication? (Too lazy to look it up.) We do have patients come in in pain. Their anesthesiologists and the operating room nurse will assess the patient, ask pertinent questions, we have the consent signed, then we medicate them for their pain. Well I got unlazy and Googled it. Actually one site I saw implied it was okay for the patient to sign a consent even if they were on pain medication as long as it was well documented that the patient was evaluated as being capable of understanding. It makes sense....you come in with vague pain, are given pain meds, then it is realized you need surgery.

Legally all nurses are doing is witnessing that that correct patient signed that form. As another nurse said, kind of like a notary witnesses a signature, the notary has no idea, obligation, to know anything about the customer or what form they are signing.

wanderlust99 · Feb 17, 2015

I was going to start a thread about consents. We do hand written from a faxed order that is usually typed. It just doesn't make sense not to streamline it and let us print something from Epic that the patient could just sign. Rewriting it is when errors occur.

Anyone use Epic and do something like this?