An audit of consent for allograft use in elective orthopaedic surgery

Exploring healthcare professionals' perspective of the process of obtaining consent for adult patient's having planned surgery: A scoping review

AIM

The aim of this scoping review was to provide an overview of the literature about the process of obtaining consent from adult patients undergoing planned surgery from the healthcare professionals' perspective and analyse knowledge gaps.

BACKGROUND

The process of obtaining consent for planned elective surgery manifests an individual's fundamental right to decide what happens to their body. The process is often suboptimal and problematic, placing a significant resource burden on health systems globally. Deficiencies in the documentation on consent forms have also been shown to increase the risk of operating room error.

DESIGN

Scoping review.

METHODS

Arksey and O'Malley's (International Journal of Social Research Methodology, 8, 2005 and 19) five-step scoping review methodology was used.

RESULTS

Fifty-three articles were included; 39 primary and 14 secondary research publications. Three key findings were identified; there is currently low-level evidence about surgical consent processes to inform clinical practice; junior doctors obtain surgical consent frequently, yet this process was likely undertaken sub-optimally; and current knowledge gaps include capacity assessment, decision-making and pre-procedural consent checks.

CONCLUSION

Planned surgical consent processes are complex, and both surgeons and perioperative nurses are essential during the process. While surgeons have responsibility to obtain consent, perioperative nurses provide a safety net in the surgical consent process checking the surgical consent information is correct and has been understood by the patient. Such actions may influence consent validity and patient safety in the operating room. Knowledge gaps about capacity assessment, decision-making, pre-procedural checks and the impact of junior doctors obtaining consent on patient understanding, safety and legal claims are evident.

RELEVANCE TO CLINICAL PRACTICE

This review highlights the importance of the surgical nurse's role in the planned surgical consent process. While the responsibility for obtaining surgical consent lies with the surgeon, the nurse's role verifying consent information is crucial as they act as a safety net and can reduce error in the operating room.

NO PATIENT OR PUBLIC CONTRIBUTION

The authors declare that no patient or public contribution was made to this review in accordance with the aim to map existing literature from the healthcare professionals' perspective.

Poor compliance documenting informed consent in trauma patients with distal radius fractures compared to elective total knee arthroplasty

Background

The purpose of this study was (1) to evaluate the adequacy of informed consent documentation in the trauma setting for distal radius fracture surgery compared with the elective setting for total knee arthroplasty (TKA) at a large public hospital and (2) to explore the relevant guidelines in New Zealand relating to consent documentation.

Methods

Consecutive adult patients (≥16 years) undergoing operations for distal radius fractures and elective TKA over a 12‐month period in a single‐centre were retrospectively identified. All medical records were reviewed for the risks and complications recorded. The consent form was analysed using the Flesch Reading Ease Score (FRES) and the Simple Measure of Gobbledygook (SMOG) index readability scores.

Results

A total of 133 patients undergoing 134 operations for 135 distal radius fractures and 239 patients undergoing 247 TKA were included. Specific risks of surgery were recorded significantly less frequently for distal radius fractures than TKA (43.3% versus 78.5%, P < 0.001). Significantly fewer risks were recorded in the trauma setting compared to the elective (2.35 ± 2.98 versus 4.95 ± 3.33, P < 0.001). The readability of the consent form was 40.5 using the FRES and 10.9 using the SMOG index, indicating a university undergraduate level of reading.

Conclusions

This study has shown poor compliance in documenting risks of surgery during the informed consent process in an acute trauma setting compared to elective arthroplasty. Institutions must prioritize improving documentation of informed consent for orthopaedic trauma patients to ensure a patient‐centred approach to healthcare.

Association between the introduction of a structured form and the quality of diabetes in pregnancy clinic care

BACKGROUND

Pregnancy in women with pre-gestational types 1 (T1DM) and 2 (T2DM) diabetes mellitus can be a clinical challenge. This study assessed the association between introducing a structured diabetes in pregnancy proforma, on the quality of medical record documentation and pregnancy outcomes in women with T1DM and T2DM.

AIMS

To evaluate the impact of a proforma on the quality of documenting medical records and pregnancy/neonatal outcomes in women with pre-gestational diabetes.

METHODS

This was a retrospective two-cycle audit: pre- and post-proforma introduction. The documentation quality was assessed based on the rate of missing pre-pregnancy/first trimester haemoglobin A1c (HbA1c), third trimester HbA1c, folate intake and dose, retinopathy and nephropathy progression. Changes in pregnancy outcomes were assessed by mode of delivery, preterm delivery, mean third trimester HbA1c, pre-eclampsia and foetal outcomes.

RESULTS

The pre- and post-proforma periods included 91 and 41 pregnancies, respectively. The quality of documentation improved in the post-proforma phase with the rate of missing data declining from 63.4% to 36.6% (P = 0.005) for pre-pregnancy/first trimester HbA1c, 30.8% to 12.2% (P = 0.009) for periconceptional folate intake, 42.9% to 14.6% (P = 0.001) for folate dose, 100% to 31.7% (P < 0.001) for retinopathy progression, 92.3% to 19.5% (P < 0.001) for nephropathy progression and 31.9% to 7.3% (P = 0.016) for third trimester HbA1c. Macrosomia significantly reduced in the second cycle (49% vs 21% P = 0.003).

CONCLUSION

The quality of documentation improved significantly which is likely attributable to the implementation of the proforma. This study supports the use of structured documentation to reduce variation in care and potentially improve pregnancy outcomes.