Informed Consent: What is the best practice?

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Transcript

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You are listening to Vital Signs, a podcast for sentara providers. Welcome to the episode titled Informed Consent.

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What is the best practice in today's episode? We are joined by Steven Friedrich, Director of Risk Management.

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Before we turn things over to the team, let's go over some important CME announcements.

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This episode has been accredited for AMA PRA category one credits for detailed accreditation and designation information,

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along with disclosure information please visit the show notes. This information can also be found on our website,

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www.Sentaracom or http://www.sentara.com/physician

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education as well as always reaching us by email at physicianeducation@sentara.com.

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Here is Steve.

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Hello and welcome to this short presentation on informed consent. Informed consent is one of the many routine activities that are performed

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multiple times a day in the course of our delivery of health care to the patient.

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In fact, it has become so routine that it is easy to fail in realizing its critical importance.

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I'm Steve Friedrich and this presentation comes at the subject from the standpoint of you, the provider. After many years as a risk professional,

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I can assure you it is one of the most important documents you will ever create. And therefore,

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it is important that it be done thoroughly and accurately.

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What is informed consent. Of course, informed consent takes the form of a general conversation between you and the patient about

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the procedure that is about to be performed, expected outcomes and certainly should cover the risk benefits and even the alternatives that exist to the

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procedure.

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It essentially serves in a sense as the documented contract about the conversation you had with the patient.

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Another purpose it serves is to offer a form of protection to not only the patient but also you the provider.

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Invariably, when the patient is dissatisfied with the outcomes or their expectations haven't been met,

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we many times return to the informed consent document as a record of the previous discussion and agreement.

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Who obtains the consent from the patient? One might assume it is always the physician and in many instances,

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it will be however, legal statutes are very clear in defining the healthcare provider,

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which can take many forms. Some examples would be an advanced practice provider operating under the general supervision of

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a physician. It could be a health care technician about to administer a vaccination in the clinic.

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Regardless, it should always be the provider that has the most and the best knowledge of the patient and the one who will actually be performing

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their procedure.

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Who gives you the consent to proceed? In the case of adult patients the answer is clear,

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only the adult patient receiving the procedure unless of course, there is some other legal entity that has superseding authority for

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the consent.

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In the case of minors, it can become a little more complicated and even at times a bit confusing.

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There are many parties associated with minors who are authorized to provide consent in certain instances and they are listed here.

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In emergency situations where no consent authority is present, the situation is different and we will talk about that in a later slide.

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I do want to make special note of times when a minor generally over the age of 14 can consent for their own care.

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These are specific to STD testing, substance abuse, and mental health counseling and birth control.

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In cases where a minor is pregnant, they are the consent authority for the child they carry throughout and or beyond the delivery.

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In the eyes of the law, some miners are already viewed as adults. These minors are considered what is termed emancipated,

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meaning they are no longer under the auspices of a parent or other adult entity who would intervene in their care.

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There are other instances listed here but the key is to have general knowledge of these provisions and always contact risk manager.

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should you have questions rather than ever assume.

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Let's talk a minute about patients who can't consent for their own care. There are specific provisions set down by law that must be followed

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to the letter. This slide lists the precedent order of entities authorized to consent.

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A comment about siblings, sibling's children, and parents: There is no order of importance for authority designation.

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In other words, the oldest adult child has no more authority than the youngest adult child.

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It can be any. The same holds true for adult siblings and parents of the patient.

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An important note however, is before any of the individuals on this list are involved you as a provider need to ensure a formal

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capacity determination has been performed and documented. This requires certain things such as two providers.

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One being a clinical psychologist or other mental health professional expert in this area.

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This slide pretty much speaks for itself in the case of saving life, limb or other extreme circumstance,

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consent may not be required because time is of the essence. It is better to err on the side of providing the care when no other competing

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legal document would preclude you from doing so. For instance, blood transfusions for Jehovah Witnesses or other complicating

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factor that may require you to seek immediate counsel or expertise to guide you accordingly.

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Obtaining informed consent is a two step process and both steps are equally important.

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The conversation with the patient typically done face to face is your opportunity to really outline in detail the nature of the procedure and process.

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It also is the best time for you to press a patient to ask any questions they may have provide answers and also alleviate any anxiety they may

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express before the procedure is performed.

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It is during this conversation that you get the best sense of the patient's commitment or readiness to proceed through their statements,

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questions, body language and other cues.

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Completing the document accurately and thoroughly ensuring the proper signatures and date is critical

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as well.

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As this slide attests whether the consent is paper or electronic, the most important factor is ensuring all the necessary components

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are included in the document.

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Consents are generally valid for 60 days unless that time frame is shortened by one of the mitigating factors listed on this slide.

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Regarding the question about whether an additional accompanying notice required or necessary as a risk professional,

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I always advise this be done.

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Because the standard consent forms used cannot possibly ever capture all the various things covered in your discussion with the patient,

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it only makes sense to memorialize this in an accompanying note. You can always give a copy of the note to the patient as well

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so there is absolutely no confusion or question about what is about to be performed.

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Abbreviations typically stay away from them on the actual consent documents signed by the patient.

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They are nothing but a recipe for trouble. They can be used however, in your accompanying note.

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This slide lists some examples of procedures requiring consents. Be advised that these examples are hardly all-inclusive.

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Vaccinations require consent. Many radiological procedures require consent. Certain testing requires consent.

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Again, if you are unsure, please contact risk management or your clinical leadership team for guidance.

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Can consents be obtained after the procedure under any circumstances? No,

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in capital letters, full stop. Never.

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It is also wise to review the information provided on this slide pertaining to any delay in treatment or procedure that may require you to obtain

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a new consent.

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What about add on procedures? As we all know many times the procedure

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is performed and the nature of what is discovered can drastically alter the clinician's plan and extent of attack.

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Can they proceed without fear of liability to serve the patient in a greater capacity as a result of what is discovered during the procedure?

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It all goes back to the detailed thoroughness of what was documented in the original consent form about add-ons or contingencies

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that may arise. Make sure that this is addressed in the original document executed.

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This brings todays presentation to a close. We hope you found the information informative and useful.

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You are a highly skilled professional in your area of expertise, ensuring the simple matter of thorough and accurate informed consent is performed,

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will protect you against detracting from your otherwise excellent care to the patient. Thank you for attending today's session.

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You've been listening to Sentara's Vital Signs, a podcast for Sentara providers. As a reminder,

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read today show notes for information about claiming your continuing education credits. Well,

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that's it for now, but we will be back soon with another episode of Vital Signs, a podcast for Sentara providers --

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the podcast that provides evidence-based education programs for physicians and health care providers on the go.