Regarding surgical consents

[sharann, BSN, RN]

Hi O.R nurses,

I work in recovery and we have been having some issues regarding patients from the ED or floors coming down without consents signed or even prepared. They have the order bu the problem I see often is that the surgeon has not spoken to the patient yet(they wait until they are down in pre-op or pacu after hours to see the patient). Understandably the ED or floor nurse soes not want to witness a consent that has not been given!(I am in full agreement). The problem is I am not sure of the legal or ethical ramification present if the PACU or surgical nurse witnisses the consent(after it is given of course). Is this ok? I have been told once the patinet is in the surgerical area it is considered "coercion" to have them sign it(like a conflict of interests)

What do you say?

Thanks

[Mourkoth]

If it is an Emergency case and the patient is from the ER, then a consent in not absolutely necessary. It is preferable but not necessary. If it is an in-patient and the case is not an emergency and the physician had ample time to get a consent, then the OR nurse shouldn't allow the patient to go into the OR without a proper signed and very specific consent. The Circulating nurse can hold up the works until the paperwork is in order.

[maeyken]

Our patients are not allowed to leave the floor (or day surgery) unless the consent form is present. This has made for some unhappy surgeons from time to time... but it's the rules. Our porters know that they are not allowed to transport a patient to the OR without a signed consent form.

[sharann, BSN, RN]

Thanks to you both for the answers. Is an appendectomy considered an emergency when the patient is stable and has been in ED for 8 hours? What is done in this case. We are not supposed to accept patients from the floors or day surg without consents either but the emerg room is different(even when no emergency surgery)

[shodobe]

Unless the patient is bleeding out or has a dissecting AAA, thena consent should still be gotten from a family member. Surgeons can write in their progress notes that the operation is necessary and the patient will die without intervention and this is exceptable when relatives are not available. This is for California and each state has their rules to follow. Our state consent manual is about 10 inches thick! Appys are really not a dire emergency but need to be done in a timely matter and ALL patients should have a consent signed. Now we get into a INformed Consent where the surgeon talks to the patient and goes over the details of the surgery and answers all questions. Only the surgeon can get an Informed Consent. Nurses, or really any healthcare worker, can get a consent signed and can witness the patient's signature. You are only stating that the signature is the patient's or their legal agent. Like I said, unless the patient is in danger of dying on the spot, a consent needs to be obtained even from the ED. We could spend all day talking about this and as stated, each state is different and each hospital has their rules on this so answers will vary.