Whose responsibility To Get Informed consent for Surgery?

[copycat]

An elderly lady with a history of alzheimers who broke her hip was admitted for surgery. The pt was admitted by th floor supervisor (not sure who took pt to unit for admission). Was later seen by surgeon who had lengthy discussion about surgery time, procedure etc. Later, lady was taken to Or by said supervisor only to realize that the consent form was not signed. The relatives by then had left the hospital. I gather doctor was upset. The son had to be called back to hospital to sign the consent. Now who do you think drop the ball.yes the person admitting and the person who transported the pt to OR should make sure the form was signed, but why didn't the doctor get the son to do it. Now the blame is on the nurses that we are iresponsible.

[Jolie, BSN]

Unquestionably, it is the surgeon's responsibility to get the consent form signed.

[burn out]

Where I work the physician is responsible for talking with the family and patient explaining the procedure and answering question and he actually fills out the consent and puts it unsigned on the chart. It is the nurses responsiblity to see that it is signed and witnessed properly.

[subee, MSN, CRNA]

Where I work the physician is responsible for talking with the family and patient explaining the procedure and answering question and he actually fills out the consent and puts it unsigned on the chart. It is the nurses responsiblity to see that it is signed and witnessed properly.

This patient obviously cannot sign a consent but telephone consents are perfectly legal.

[crb613, BSN, RN]

Where I work the physician is responsible for talking with the family and patient explaining the procedure and answering question and he actually fills out the consent and puts it unsigned on the chart. It is the nurses responsiblity to see that it is signed and witnessed properly.

I was taught in school that it was the doctors responsibility to explain & get it signed. Now that I am working I find the doctor explains the procedure, but the nurse gets it signed & witnessed.

[Jolie, BSN]

Where I work the physician is responsible for talking with the family and patient explaining the procedure and answering question and he actually fills out the consent and puts it unsigned on the chart. It is the nurses responsiblity to see that it is signed and witnessed properly.

I realize this is common practice, but it has never made sense to me and I have never gone along with it.

If the surgeon is taking the time to speak in-depth with the patient and family, why not take 2 seconds more and get a signature? Putting the form on the chart for the nurse to witness at a later time leaves the possibility that the patient will have more questions that the nurse can not legally answer. I have NEVER witnessed a consent form unless the surgeon was present in the room at the same time.

[Larry77, RN]

I used to work on the surgical floor and never have seen a doc get the consent signed. They explain the procedure to the patient and family, the nurses get the consent for surgery and blood products (if needed).

If that was my patient being sent to surgery I would feel like it is my responsibility to make sure that the consent is signed. If your not comfortable with having them sign it yourself fine, but it is still part of your job to make sure that it is signed, so I guess in your case you have to hand the form to the doc and tell him he needs to have it signed...good luck with that...he he.

I just say, "So did the doctor explain the surgery that you will be having?". Then I have them tell me what they are having done (and make sure it matches the form). Lastly I ask them if they have any other questions. We all know that docs aren't always very good at explaining things in layman's terms, especially surgeons. All these would apply to the family if the pt is unable to sign d/t age or disability.

[caroladybelle, BSN, RN]

IT IS THE SURGEON'S DUTY TO GET INFORMED CONSENT.

PERIOD!

Now if they choose to put an order on the chart for nursing to obtain signature on the form, they can get it signed, but only if the MD has fully discussed the procedure to the legally designated individual. But it is not our primary responsibility to explain anything. But if it doesn't get done, the MD bear the final responsibility. Notify them (which usually ticks them off and they start acting like a martyr) and leave it for them.

Now as to what actually happens, varies by facility. I have dealt with GIs that will never even see/speak to a patient before phoning in prep orders for an endo prep and to get a signed consent. In a few cases, it is a repeat procedure for someone (I have UC and it is routine). But in many, the GI has not even had contact with the patient. I see if they want the prep, explain issues and they decide whether they want to speak to the MD - where upon I page them (hopefully at a highly inconvenient time) explain that they will not take the prep and sign consent until the MD speaks to them.

I am completely symphathetic to how busy MDs are, and all the other legal and financial problems that they have, but come on. How hard is it to take a consent with them, and get it signed?

I will say another issue in reference to consents in the ER. If the MD discusses the procedure in the ER....when the patient is awake, coherent, when the appropriate relatives are available, or in some cases, the appropriate translations available...the consent should be signed there. As the "informed consent" took place there, it makes sense that the form (by MD and/or nurse)be completed there. There is nothing quite so annoying as a nurse that witnessed the Spanish translator discussing the procedure, answering the questions (assisted by MD) who has access to the Spanish forms, sending the patient to the floor (which has no translator or Spanish forms, nor the MD on hand) still to be consented. And, yes, it has happened repeatedly.

It is the surgeon's responsibility. If they have requested nursing to obtain the signature, and for whatever reason that will not happen, we notify them and it is back in their court.

[MU/WVUGRADRN]

IT IS THE SURGEON'S DUTY TO GET INFORMED CONSENT.

:yeahthat:

I worked in a hospital in Colorado. It was HOSPITAL POLICY that the surgeon got the consent signed. It was wonderful! The surgeons would pick up a consent at the nurses station, take it to the room to talk to the patient. The pt would sign the consent, the surgeon would witness the signature. My responsiblity to this process was to assure that the patient understood the proposed procedure before they went to surgery.

WOULDN'T THIS BE AN IDEAL WORLD IF THIS WOULD BE AN ACCEPTABLE ANSWER TO THE CONSENT ISSUE.

Now, some people say the person witnessing the pt's signature should not be anyone who may "benefit" from the pt having the procedure. I guess they think the person obtaining consent may be coercing the pt's signature.

We live in such a complicated world.

Wouldn't it be nice if the surgeon talked to the pt, obtained consent, witnessed the signature and there would be a sentence at the bottom of consent that would say something like "patient verbalizes understanding of above as discussed with physician"?????? Or something to that effect. I would be much more comfortable with that.

[TazziRN, RN]

surgeon explains procedure and answers questions and words the consent. staff obtain signature and witness sig, then charts "consent for xxxxx obtained after procedure explained by dr. ----, pt states understanding of procedure and does not have questions." or something to that effect.

[elkpark]

Just a reminder that the OP's profile under (her?) user name notes that she is in Kingston, Jamaica. I will be the first to admit that I have no idea what the rules, customs, or expectations are in Jamaica regarding op permits.

[Katnip, RN]

Your hospital should have a consent policy in writing somewhere. It would probably help all the staff to review that to avoid further confusion.