Consent for Common Obstetric and Gynaecological Procedures Presented by Dr Stella Mwenechanya Calderdale and Huddersfield NHS Trust
Aims and objectives Compliance of current practice to GMC/RCOG advice Looking at process, documentation More specifically: Who is taking consent Serious and frequent risks documented.
Background and Standards Legal document may help reduce complaints/litigation GMC: informed consent By investigator/operator Delegation to suitably qualified and trained person Sufficient knowledge of procedure and risks
Standards RCOG consent advice given on several gynae procedures and C/S Based on DOH/welsh assembly consent form 1 Advice on risks to be discussed for each procedure also given.
Method Retrospective review of cases July and August 2007 August: new SHO intake July: SHOs in post atleast 4 months Theatre Registers Procedures looked at were Abdominal hysterectomy for heavy periods Caesarean section Diagnostic hysteroscopy Diagnostic laparoscopy Laparoscopic tubal occlusion Pelvic floor repair and vaginal hysterectomy for prolapse
Information looked at Patient identification Name and benefits of procedure Serious and frequently occurring risks Extra procedures to/not to be carried out Leaflet Anaesthetic Health professional completing the form compared to performing the procedure and their competency Patient signature Confirmation of consent
Results 57 cases analysed. (10 C/S) 100% compliance in: Patients’ surname, first name, DOB and NHS/hosp number Name of procedure appropriate benefits 28%(16) named consultant
Risks Serious and frequent risks discussed in 98% Documentation variable for: Procedure specific risks Additional procedures 18% of consent forms contained none
Abdominal Hysterectomy
Caesarean Section
Diagnostic Hysteroscopy
Diagnostic Laparoscopy
Laparoscopic Tubal Occlusion
Pelvic Floor Repair & Vaginal Hysterectomy
Leaflet/Anaesthetic 32%(18) Leaflet 79%(45) type of anaesthetic ticked
Doctor Signature/Date/Name/Position 96%(55) Signed and Dated 93% Printed name (legible) 19% were complete by consultants 21% by associate specialists 46% by registrars 7% by SHOs 43%(25) completed by the health professional performing the procedure
Competency 94%(54) competent to perform the procedure 3 VTS SHOs 2 c-section 1 diagnostic laparoscopy
Patient Signature/Date/Name 96%(54) Signed 84% Dated 68% Name printed
Conclusion Good compliance with guidelines on documentation of patient/procedure details Procedure benefits Person obtaining consent Serious and frequent risks Reasonable compliance with local guidelines Poor compliance with RCOG Compliance also to be improved in: Leaflets provision/documentation Anaesthetic discussion Named consultant
Recommendations Use of procedure specific consent forms to ensure all risks discussed with patient. May even reduce repeat C/S rate Registrar Inductions to include guidelines in obtaining valid consent. Audit of local risks for each procedure. Re-audit in 3years
Royal College of Obstetricians and Gynaecologists Setting standards to improve women’s health Risk Management and Medico-Legal Issues In Women’s Health Joint RCOG/ENTER Meeting Please turn off all mobile phones and pagers