Question about POA

[rnaturcervix]

I work in an outpatient surgery center that has a busy Endo department. One doctor frequently scopes pts that have serious mental retardation, dementia, alzheimer's, etc. 99% of the pts have a POA in place to consent for their procedures, but we do see some that don't. My question is from a pre-op standpoint. I don't feel comfortable having these pts sign consent forms when they can't even tell me the doc's name, or when asked what procedure they're having, after a lot of coaching, say "check my butt (colonoscopy)". I always involve my director, but his response (after he rolls his eyes) is to talk to them like a 5 year old because that's their mental capacity. I refuse to get these pt's ready! By his logic, my son (9) could sign his own consent if he was able to say his name and that he was having his tonsils removed. How can I obtain informed consent if the pt doesn't have the ability to comprehend? Anyone else have issues like this, and what has been the resolution?

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[Asystole RN]

The legal standard is the ability to understand the risks and consequences. There are some more specific standards depending upon the state like minors and the like but you have to check your local laws.

An "Informed Consent" is not a legal form or a piece of paper. Informed consent is a state of being, for lack of a better term. You can have informed consent if the risks and benefits have been explained to the patient and the patient understands those risks and benefits, the form is not needed. Even if the patient signs 100 forms, the patient cannot legally have provided informed consent with the mentation of a 5 year old.

FYI, the threshold for the need for an informed consent is the common man test. Can a common person of average intelligence understand the common risks and benefits of the procedure. If they cannot, then you need to obtain an informed consent.

The nurses role in obtaining informed consent can vary by state so you need to consult your local board's advisory opinions on the topic.