surgical consents

bellehill, RN · Feb 20, 2004

Your floor should have a policy manual with info on obtaining consent. Doctors are supposed to obtain the consent when they talk to the patient, does it happen that way...no. What the doctor will do is write the order to obtain consent for the procedure and state in their notes that they discussed risks and benefits to the patient. When I take the consent form in for the patient to sign I always ask the patient if they have any questions, has the doctor described what is going to happen, did you see the doctor, are you comfortable signing the consent. Any question and the consent doesn't get signed and the doctor or resident gets to come up and do it all over again.

It is not the nurses job to explain procedures, risks and benefits to the patient...actually it is out of our scope of practice (just like we can't relay test results). If you aren't comfortable don't do it, simple as that. They can argue but ultimately it is their job not yours.

zacarias, ASN, RN · Feb 20, 2004

I always understood that a consent must be gotten by the doctor or surgeon involved. I mean, the Doc can write an order for me to get consent, and I by myself go in and ask the patient if they feel OK about the procedure and the risks, but can I still feel safe getting their signature right then? No. The doc must explain it and get a signature from the patient. Am I wrong?

RNPATL, DNP, RN · Feb 20, 2004

Your floor should have a policy manual with info on obtaining consent. Doctors are supposed to obtain the consent when they talk to the patient, does it happen that way...no. What the doctor will do is write the order to obtain consent for the procedure and state in their notes that they discussed risks and benefits to the patient. When I take the consent form in for the patient to sign I always ask the patient if they have any questions, has the doctor described what is going to happen, did you see the doctor, are you comfortable signing the consent. Any question and the consent doesn't get signed and the doctor or resident gets to come up and do it all over again.
It is not the nurses job to explain procedures, risks and benefits to the patient...actually it is out of our scope of practice (just like we can't relay test results). If you aren't comfortable don't do it, simple as that. They can argue but ultimately it is their job not yours.

You said it perfectly. I am a lot like you in that if the patient has questions or they appear hesitant to sign, I will call the physician or resident up and they get to do it all over again! It is their job and it is our job to advocate for the patient and the patient's need to be well informed about their procedure or surgery. Nothing makes me more angry than having a physician treat the patient like they are a number (i.e. #3 case for the day). I like to remind our residents that #3 case for the day is Mr. Smith and he is having blah, blah surgery today.

:angryfire

ybmucg · Feb 20, 2004

You said it perfectly. I am a lot like you in that if the patient has questions or they appear hesitant to sign, I will call the physician or resident up and they get to do it all over again! It is their job and it is our job to advocate for the patient and the patient's need to be well informed about their procedure or surgery. Nothing makes me more angry than having a physician treat the patient like they are a number (i.e. #3 case for the day). I like to remind our residents that #3 case for the day is Mr. Smith and he is having blah, blah surgery today.
:angryfire

What do you suggest , when the patient speaks another language beside English? The doc could have explained the procedure, but you have no way to verify thus. Is there some way you can indicate this on the consent?

fiestynurse · Feb 20, 2004

Informed consent is a process, not a form. In order for the process to be legally valid, the individual doctor rendering the treatment or performing the procedure must give the patient sufficient information to make a decision whether to accept or decline the recommended treatment or procedure.

The nurse's job is to complete the form per the doctor's written order and witness the signature. The nurse should explain what the form is and what procedure they are consenting to. The patient needs to be aware of what they are signing. (be of consenting age, not be under the infuence of drugs, be of sound mind, etc.) If the patient is apprehensive about signing, then you need to notify the doctor. Even after signing the consent form, the patient can withdraw his/her consent at anytime leading up to the procedure.

chartleypj · Feb 20, 2004

Informed consent is a process, not a form. In order for the process to be legally valid, the individual doctor rendering the treatment or performing the procedure must give the patient sufficient information to make a decision whether to accept or decline the recommended treatment or procedure.
The nurse's job is to complete the form per the doctor's written order and witness the signature. The nurse should explain what the form is and what procedure they are consenting to. The patient needs to be aware of what they are signing. (be of consenting age, not be under the infuence of drugs, be of sound mind, etc.) If the patient is apprehensive about signing, then you need to notify the doctor. Even after signing the consent form, the patient can withdraw his/her consent at anytime leading up to the procedure.

I agree this is a 'process'. Where I work, it is the entirely the responsibility of the surgeon to explain the procedure including risks and benefits, as well as possible complications. It is His/Her responsibility to then have the patient sign the consent form and only then should any nurse who has been in the presence of the 'process' witness that pts. signature.

I wonder why any nurse would put themselves in the position of obtaining a signature for this legal document even if the surgeon wrote an 'order to obtain consent'?

I work in an OR; I would never assume the responsibility to obtain consent for my patient.

Paula

stevierae · Feb 20, 2004

Need information on obtaining surgical consents. Can a nurse obtain a surgical consents, other than in a energency situation? Can you also tell me where I can locate a policy and procedure on obtaining surgical consents.

Go to http://www.AORN.org

You should be able to find a wealth of info about informed consents.

There is a good letter in the August 2003 issue of AORN Journal addressing responsibilities involved with informed consents. If you cannot access it, p.m. me and I will p.m. or email you a copy.

kc ccurn · Feb 20, 2004

Need information on obtaining surgical consents. Can a nurse obtain a surgical consents, other than in a energency situation? Can you also tell me where I can locate a policy and procedure on obtaining surgical consents.

The doc's used to talk with the pt, leave the consent and write an order to have consent signed. Now we no longer have anything with the consent. The doc's have done a great job of getting their own consents signed.

I personally feel that it is the doc's responsibility and liability, not mine, since he/she is the one doing the procedure.

kc ccurn · Feb 20, 2004

What do you suggest , when the patient speaks another language beside English? The doc could have explained the procedure, but you have no way to verify thus. Is there some way you can indicate this on the consent?

We have language translation phones that have two handsets, you dial a number that a service that provides translators for a variety of languages. The family member can stand next to the doc/nurse/social worker, whoever holding one handset while we're on the other and have a discussion. They are great because you can use them at anytime of the day. Another option we have is a resource list of hospital personnel that speak fluent languages. The down side is that the list is not always kept updated, and not everyone is available 24/7.

Luv the phone!

RNKPCE · Feb 21, 2004

I think Fiesty Nurse described it best by saying we are just witnessing their signature.

What I hate is when we witness the consent for heart cath, angioplasty, coronary stent and then the patient is shocked when they have to sign for Bypass. Most doctors never tell them they have to sign for that. I explain why, in case the artery become completely occluded or dissects while in the cath lab.But if they have any questions I tell them not to sign and wait til the doctor comes in and informs the patient more thoroughly.