Oxo & Consent

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turnupthevapor

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We have a new pain protocol where we give a touch of oxycontin (10) to some of our opioid naive TJR PT's preop. Our Admitting RN's brought up a decent point to me...... Can the patient still sign consent if they have received the oxycontin a few hours earlier? Chronic opioid patients I have no problem with but being that you have 40% blood level of the the 10 oxycontin in one hour is this clinically relevant? I don't think it is clinically significant in its effect on decision making as it is not a benzo but want to throw it out there.

thanks peeps

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If a lawyer finds out that the patient was given a medication that has the potential to impair the patient's judgment, your consent will become more worthless than it usually is (consents are in general worthless and only provide lawyers with ammunition against you).
You might think it's OK clinically, and you are probably right, but this has nothing to do with science or medicine.
 
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In my state narcotics are OK before a consent is signed but benzos are not
 
We have patients coming up from the ER all the time who have received dilaudid or morphine. We still consent them.
 
How many appys recieve morphine before surgerical consent? This should be a non-issue. Anyone have a case where a lawyer found a consent worthless?
 
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How many appys recieve morphine before surgerical consent? This should be a non-issue. Anyone have a case where a lawyer found a consent worthless?
In every malpractice case the first thing that a lawyer attacks is the consent, and they always find something wrong with it!
So if a patient has been given an opiate and the lawyer decides to focus on that point, it will be up to the expert witnesses and ultimately to the jury to decide if the opiate affected the patient's ability to consent.
 
In every malpractice case the first thing that a lawyer attacks is the consent, and they always find something wrong with it!
So if a patient has been given an opiate and the lawyer decides to focus on that point, it will be up to the expert witnesses and ultimately to the jury to decide if the opiate affected the patient's ability to consent.

except there is likely a massive amount of case law to be cited in that area and a lawyer isn't even going to go there if they know they will not win that point
 
So heroin would be OK too?:poke:

Not that I disagree with what has been said, but keep in mind we're talking about an entirely different scenario- everyone is bringing up examples of patients who have active pain, being treated with pain meds.

The OP is talking about an opiate-naive patient who has received a significant dose of heavy duty narcotic. and isn't in pain yet.
 
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The OP is talking about an opiate-naive patient who has received a significant dose of heavy duty narcotic. and isn't in pain yet.

He's also talking about a small oral dose of oxycontin of which a large percentage is extended release. It's not like someone took grandma into preop and shot her up with 20 mg of IV morphine.
 
We're also talking about an elective procedure that was scheduled in advance with notes from the surgeon stating they discussed the procedure and need for anesthesia (hopefully), and maybe even a call from or visit to pre-anesthesia screening.
 
except there is likely a massive amount of case law to be cited in that area and a lawyer isn't even going to go there if they know they will not win that point
All a lawyer needs to dispute your medical opinion is the opinion of an expert witness who disagrees with you, and trust me, for the right price many of the people who wrote the textbooks and taught you in residency will be eager to look you in the eye and say your consent was invalid.
Many of the big names in anesthesiology are famous for doing exactly that.
 
If a lawyer finds out that the patient was given a medication that has the potential to impair the patient's judgment, your consent will become more worthless than it usually is (consents are in general worthless and only provide lawyers with ammunition against you).
You might think it's OK clinically, and you are probably right, but this has nothing to do with science or medicine.
So, would you do the OP's case, or not?

I would.
 
So, would you do the OP's case, or not?

I would.

Depends. If in my clinical judgement they are impaired and they haven't signed an anesthesia consent, then no (for an elective case). If they do not appear to be impaired, then yes. If they are impaired but saw anesthesia yesterday and signed consent, then yes.

In real life we gave oxy/pregab/celecoxib to all of our joints in pre-op and none of them were impaired by the time we rolled back.
 
Depends. If in my clinical judgement they are impaired and they haven't signed an anesthesia consent, then no (for an elective case). If they do not appear to be impaired, then yes. If they are impaired but saw anesthesia yesterday and signed consent, then yes.

In real life we gave oxy/pregab/celecoxib to all of our joints in pre-op and none of them were impaired by the time we rolled back.
For opiate naive cocktails I agree the anesthesia consent should be signed prior to administration of meds. But then along those lines isnt the surgical consent invalidated? What we should do is treat opiate naive patients like regional blocks patient gets both consents signed then recieves said cocktail.
 
All a lawyer needs to dispute your medical opinion is the opinion of an expert witness who disagrees with you, and trust me, for the right price many of the people who wrote the textbooks and taught you in residency will be eager to look you in the eye and say your consent was invalid.
Many of the big names in anesthesiology are famous for doing exactly that.

they can do whatever they want. well established legal precedent will be against them as will my expert medical opinion that the patient was alert and oriented and appropriate during the consent. It's a complete nonissue. And while "big names" will be expert witnesses, I've never heard of one testifying that a narcotic invalidates a consent form.
 
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All a lawyer needs to dispute your medical opinion is the opinion of an expert witness who disagrees with you, and trust me, for the right price many of the people who wrote the textbooks and taught you in residency will be eager to look you in the eye and say your consent was invalid.
Many of the big names in anesthesiology are famous for doing exactly that.

Isn't there provision for "reasonable" decisions?
 
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