Witnessing consent

[ILMRN]

If you didn’t actually see a consent happen, do you feel comfortable signing as a witness? Say it’s assumed the parents consented based on how they acted after the procedure, but you had no contact with them prior to the (non-emergent) surgery.

The surgeon has the consent filled out, but is missing a witness. I wasn’t present when he got consent from the parents, but because it was technically my patient my charge RN says I need to sign. Shouldn’t they have caught this during a time-out in the OR?

[ORoxyO]

This should be complete before the patient goes into the OR, well before the time out. An unwitnessed or undated consent is not considered complete.

If I need to witness a consent that I did not watch the patient sign, I show it to them and ask "is this your signature? Do you understand the procedure and have all your questions answered?" If they agree that they signed it, I'm ok with that. If they are sedated/ confused/ parent or guardian signer not present then I leave it in the hands of the person obtaining consent and do not witness it. Of course this all happens BEFORE the procedure. You should never assume consent unless it is life or limb. Even then we still try if reasonable.

[Rose_Queen, BSN, MSN, RN]

Exactly what ORoxyO said. There are so many checks that should be happening before the patient hits the OR where the missing witness signature should have been caught- the unit the patient came from (ED, inpatient, or via the preadmission process if the facility utilizes one), the nurse who was responsible for the preop care of the patient, and the nurse who took the patient to the OR. As the time out is to occur immediately before incision, even catching it then would have been too late as the patient would have already received anesthesia.

[ILMRN]

Thanks for the feedback. Normally as the patient’s primary nurse, I would’ve checked this before moving to the OR. However, it was a rush type of thing since it was unscheduled and the only time slot the surgeon had. Since there were no parents or surgeon present and they were already calling for me to bring the patient, I had to pack up and go anyway. Had the patient not become unstable after we arrived, I would’ve likely been able to address the fact the consent had no witnesses. I know everyone should be double-checking these things, but my priority had to shift being that me and the RT were the only people available who knew NRP well enough to stabilize the baby.

[FurBabyMom, MSN, RN]

If I have a patient whose consent is filled out but not witnessed, I talk to my patients/their designee/their guardian in pre-op. I ask them if they signed the form, and I ask them the printed list of questions listed on my facility's procedure consent form and indicated "to be asked if consent was not obtained in your presence". If they answer those questions sufficiently, I sign. If not, I ask the surgeon or their resident to come talk to them again.

Consent for pediatric patients is a little less clear than adults - there are so many cases kiddos are in state custody and contingencies whether parents can or cannot sign, or whether foster parents can/cannot sign.

Our surgeons try to get consent most of time, but that is impossible for some of our trauma (or other emergent) patients. If we don't know who the patient is, there is almost no way we can get consent. In our facility, based on our state laws, if we don't have consent, then the surgeon (attending) and a second attending (usually anesthesiologist from case) cosign the consent form with a notation about the patient's condition.