Question:
Dear Nancy,
What are the legal issues surrounding getting consent for surgical procedures, as it relates to pre-op/ED/med-surg obtaining consent, as opposed to the actual operating room (OR) circulator obtaining consent?
There have been multiple occasions where OR nurses have been on-call and asked to obtain consent from the patient. I see it as a patient safety issue (e.g. correct site/side procedure) and feel that whomever is taking care of the patient just prior to transferring to the OR should obtain consent. That way, the OR nurse can verify that consent as a double check. Is this more of a policy or legal issue?
Sincerely,
Denise
Nancy Brent replies:
Dear Denise,
The legal issues inherent in obtaining informed consent for, or informed refusal of, treatment, including surgical treatment, is well beyond the scope of this column. However, your submitted question is important and can be responded to generally.
There is no question that obtaining the informed consent of the patient for surgery is imperative, except, of course, in an emergency situation. Indeed, the Association of periOperative Registered Nurses has a wealth of information about patient safety, including informed consent for surgery.
One important document available is the Centers for Medicare and Medicaid Services, April 2007 Revisions to the Hospital Interpretative Guidelines for Informed Consent. Interpretive Guideline 482.51(b)(2) covers informed consent for surgery. (When you go to the association's website, click on Public Policy, then scroll down that page and click on the link to the Guidelines).
It is important to keep in mind that the practitioner who is doing the procedure or the surgery will be involved in the process of informing the patient of the surgery that is to occur. Another healthcare provider can obtain the patient's signature on the consent form if the primary practitioner does not obtain it during the informed consent process.
However, as the guideline requires, there should be a developed policy concerning all aspects of informed consent for surgery (e.g., who obtains it, what form is to be used, etc.), including the fact that unless there is an emergency, informed consent should be obtained before any surgical treatment. The policy then needs to be followed.
It makes sense legally and from a patient safety perspective that the more times a confirmation of the surgery to be done is obtained from the patient or his representative helps put the patient and his or her safety first. A policy that requires confirmation of initial consent and the procedure to be done several times at various points as the patient progresses to the perioperative suite can do much to alleviate potential errors.
Cordially,
Nancy Brent
