quick question-emergency consent

[ajaxgirl]

If a child is in need of emergency surgery and they parents or guardian cannot be contacted--would they proceed with surgery?

I think in life or death -yes

Anything that can wait -they would wait until consent is obtained

Am I correct?

[elkpark]

Yes. .

[shodobe]

Definitely yes. All a surgeon has to do, at least in California, is to make a note in the progress notes to the effect that it is an emergency and without it the child might die or suffer irreparable damage. Surgeons DO NOT sign consents. This is a misconception not only on the part of the surgeon or PCP but also the floor nurses who obtain said consents.

[elkpark]

Surgeons DO NOT sign consents. This is a misconception not only on the part of the surgeon or PCP but also the floor nurses who obtain said consents.

That is news to me -- I worked as a surveyor for my state and CMS for several years, and the CMS rules require that it is the person who is performing the procedure who discusses the procedure and provides the "informed consent" info to the client and obtains the consent -- the staff nurse is simply witnessing the client's signature on the consent form, which is v. different from obtaining the client's consent. (Which is also what I was taught in nursing school, and what I've heard every time the subject has come up during my career.) Or am I misunderstanding what you said?

[GadgetRN71, ASN, RN]

In my state, the surgeon has to sign the consent and educate the patient on risks of the procedure etc. This cannot be the RN/LPN who gets the consent-our responsibility is to make sure the surgeon has gotten consent(in a non emergency, this means the patient doesn't go to the room until it is done) and we sign as a witness if needed.

[core0]

That is news to me -- I worked as a surveyor for my state and CMS for several years, and the CMS rules require that it is the person who is performing the procedure who discusses the procedure and provides the "informed consent" info to the client and obtains the consent -- the staff nurse is simply witnessing the client's signature on the consent form, which is v. different from obtaining the client's consent. (Which is also what I was taught in nursing school, and what I've heard every time the subject has come up during my career.) Or am I misunderstanding what you said?

I agree that the nurse should not be getting the consent. The consent should be done by a provider within the surgery service who can explain the risks and benefits as well as the alternatives. While many nurses can do this, their role as patient advocate should necessarily preclude them from getting the consent. In our facility the only time a nurse needs to sign the consent is if it a telephone consent otherwise it needs the patients signature and the providers signature (or representative).

As far as the person preforming the procedure getting consent and discussing the procedure, I would respectfully disagree. We recently went through a CMS audit and this was not an issue. The specific CMS guidance is found here:

"Hospitals must assure that the practitioner(s) responsible for the surgery obtain informed consent from patients in a manner consistent with the hospital's policies governing the informed consent process."

From here:

http://www.medlaw.com/healthlaw/OSHA/9_4/cms-new-cops-on-informed-.shtml

Our hospital policy requires that the consent be obtained by a licensed provider on the surgical team. This can be a resident, fellow or PA (in our case).

As far as the OP's question, once again this is guided by hospital policy and state law. In the case of our hospital, the emergency must be certified by two physicians and the type of emergency has to fit within the guidelines for emergency surgery. For pediatric cases there are separate policies for emergency surgery on pediatric patients without consent and for surgery on pediatric patients when parents refuse consent (both emergency and non-emergency). These unfortunately have been tested both in practice and in court and found sufficient.

David Carpenter, PA-C

[elkpark]

As far as the person preforming the procedure getting consent and discussing the procedure, I would respectfully disagree. We recently went through a CMS audit and this was not an issue. The specific CMS guidance is found here:

"Hospitals must assure that the practitioner(s) responsible for the surgery obtain informed consent from patients in a manner consistent with the hospital's policies governing the informed consent process."

From here:

http://www.medlaw.com/healthlaw/OSHA/9_4/cms-new-cops-on-informed-.shtml

Our hospital policy requires that the consent be obtained by a licensed provider on the surgical team. This can be a resident, fellow or PA (in our case).

No prob -- I'm happy to be corrected. It's been four years since I left that position, so I'm not surprised that the rule has been updated or reinterpreted in that time.