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Elective Surgery is Essential - August 2020 - Subscribe to Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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ly that outcome is for him. The nurse wants to keep the OR work- flow going and therefore tells the patient to sign the form and that the surgeon will be in momentari- ly to answer his questions. The nurse closes the chart and leaves to care for other patients. Moments later the anesthesiolo- gist walks in and sees the signed form, so he pre-medicates the patient, who is now under the influence of a sedative. The surgeon comes in, and the anesthesiologist informs him that the consent form has been signed and the patient is ready for surgery. The patient is wheeled to the OR and the procedure is performed. The patient now can sue for the lack of informed consent, saying he had questions and the surgery proceeded without his permission. The surgeon can be sued even if he didn't know the patient had ques- tions. The nurse can be sued as well, which is some- thing many nurses don't realize. In this case, the nurse intervened in the physician-patient relation- ship and prevented the surgeon from fulfilling the social contract with the patient. The nurse essential- ly became the physician by not allowing the patient an opportunity to get his questions answered. Your facility could face legal action as well. Nurses can be contributorily negligent by bypassing policies and procedures. In this example, your facil- ity likely has a policy that states no surgery can start unless the patient signs a consent form. Circulating nurses or other members of the operat- ing room staff must make sure that happens, and, even though it sounds simple, it doesn't always get done. If the procedure takes place without a con- sent form being signed, your facility could now be found negligent. The physician can still be sued as well, but the damages would now be split between the surgeon and your facility. A better approach In the court's eyes, nurses don't obtain informed consent, they witness and facilitate it by making sure it happens and is documented. If they don't facilitate it to the best of their ability and the con- sent wasn't obtained, they could be found liable. Tell nurses that if this scenario ever comes up, they should put the consent form down, wait for the surgeon and patient to converse, then make sure the form gets signed afterward. They shouldn't be so focused on getting other work done and think this essential conversation can wait. It can't. Nurses who have patients sign consent forms before all their ques- tions are answered by the operating surgeon interject themselves into a very important relationship, and potentially into a legal fray. You might be busy for months giving depositions and going to court. You could argue the surgeon in this example put the nurse in a bad position by not having the con- versation with the patient earlier in the periopera- tive process. The nurse, however, did the same thing to the doctor by leaving to take care of anoth- er patient. She should have told the patient that the surgeon would be in soon and hold off on getting the form signed until his questions were answered. Surgeons should avoid waiting until moments before procedures begin to have informed consent conversations. Doing so will not only help the sur- geon and the facility avert a legal case, but also puts you in the role of patient advocate. Allowing a patient to have a procedure per- formed before all their concerns are addressed is negligent. While it's best for the conversation to take place well ahead of time, sometimes that's not possible. In these instances, nurses should confirm patients don't have any more questions before the procedure. If patients don't, nurses should docu- ment the surgery can proceed. OSM Mr. Duffy (dodger6967@gmail.com) is director of the health systems management program at the Marcella Niehoff School of Nursing at Loyola University in Chicago. A U G U S T 2 0 2 0 • O U T P A T I E N T S U R G E R Y . N E T • 1 9 Surgeons should avoid waiting until moments before procedures begin to have informed consent conversations.

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