Separate anesthesia consent form

[deleted126335]

Anesthesia consent forms.
Do you use them?
what do you do for the patient unable to give informed consent whose POA is not available for non emergent surgery?

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[Chloroform4Life]

I didn't use it during residency at a big teaching hospital. Just documented on preop that r/b/a discussed and patient or family agreed to proceed.

Im using it now at my small community hospital and outpatient surgery center because it's hospital policy. Its in the same piece of paper as the surgical consent and they usually have patient or family member sign it when they sign for the surgery consent. I sign it when I see the patient.

If patient can't sign, I try to talk to family members. If none are available, I doccument that I tried to contact, but none are available.

 

[fakin' the funk]

We have full hospital wide EMR, including pre/intra/postop with vitals autoimported, etc.

On the plan part of the preop documentation, there are buttons for risks discussed like HA, N/V, bleeding infection etc. So in effect we have a totally separate anesthesia consent. The patient doesn't sign it, though.

 

[Ronin786]

We have full hospital wide EMR, including pre/intra/postop with vitals autoimported, etc.

On the plan part of the preop documentation, there are buttons for risks discussed like HA, N/V, bleeding infection etc. So in effect we have a totally separate anesthesia consent. The patient doesn't sign it, though.

Ditto.

If risks and benefits were discussed and explained, do you really need a generic consent form? Especially one that doesn't really mean much in a court of law.

 

[soorg]

Up until five years ago at our hospital it was included as part of the surgical consent, which was awesome. But some d-bag somewhere sometime said that it's not good enough. So now we have a separate anesthesia consent form, which I hate. Patients always put their fingers in their mouth when you ask if they have loose teeth or dentures, and then you have to give them your pen. Gross.

 

[Impromptu]

Something we have is a separate consent form for those with pre-existing DNRs, which effectively suspends the DNR in the perioperative period. I thought everyone did this until I went to a simulation course at Vanderbilt and during a discussion found out that none of the other participants nor Vanderbilt had such a form. I tell the patients that most people are intubated during anesthesia and this form is just for clarity. I also tell them that we are checking option 3 which says that if we don't think they are going to recover we'll follow their DNR, but it might involve waiting until all of the anesthesia wears off, so we'd keep them alive until we could figure out the full extent of the derangement, should it happen. We don't want to pull the plug if you are going to be back to their baseline.

This is on top of the separate anesthesia consent form.

 

[ph8]

Anesthesia consent forms.
Do you use them?
what do you do for the patient unable to give informed consent whose POA is not available for non emergent surgery?

Yes.
If non-emergent surgery and no one available to consent, then no surgery.

The surgical consent process at the VA medical centers is by far the most efficient I have seen. Yes, I'll concede the VA has numerous problems and short-comings, though I think the consent is one thing they did get right. One form, surgery + anesthesia + blood consent (can decline if Jehovah's Witness), pt has to sign all of it at once, electronically scanned and signed, and viewable in VA EMR.

On the day of surgery, Anesthesiologist would still see the pt, HPI, exam,....go over the plan, answer questions, etc, but all the paperwork was already done.

 

[Chloroform4Life]

Yes.
If non-emergent surgery and no one available to consent, then no surgery.

The surgical consent process at the VA medical centers is by far the most efficient I have seen. Yes, I'll concede the VA has numerous problems and short-comings, though I think the consent is one thing they did get right. One form, surgery + anesthesia + blood consent (can decline if Jehovah's Witness), pt has to sign all of it at once, electronically scanned and signed, and viewable in VA EMR.

On the day of surgery, Anesthesiologist would still see the pt, HPI, exam,....go over the plan, answer questions, etc, but all the paperwork was already done.

So they basically sign the anesthesia consent before r/b/a of anesthesia is actually explained to them, right? This is how they do it at my place as well.

What do you do when the anesthesia consent is signed already by a family member and on day of surgery, you can't get in touch with a family member and patient is an intubated icu patient?

 

[amyl]

old hospital had a preop form that said r/b/a/p discussed and pt didn't sign it and it was no big deal. current hospital does have a separate consent and I absolutely hate it. such a pain

 

[Ashers]

In residency the only anesthesia consents that needed to be signed were for procedures that didn't necessarily need an anesthesiologist (really only EGDs or colos), and for OB (for epidurals or for c-section anesthesia).

In fellowship I just clicked which risks I discussed with the patient.

In my (now) former job, I had separate anesthesia consents for everything at one location. If it was an elective case, and I couldn't find someone to give consent, the case got delayed until I could or canceled. In a true emergency when the patient couldn't consent and there was no one to provide consent, I had to fill out the form, say I couldn't obtain consent, and then have another doctor (usually the surgeon) sign the form, or I'd hear back from medical records that there was no consent. In other locations 1 place I had to acknowledge that I discussed r/b/a with the patient and document what I said. In another location, I didn't have to document anything about r/b/a after talking with the patient, but I did anyway.

In my next job, I'm going back to where I did fellowship, so I'll find out soon if any of the rules have changed since I left.

 

[ph8]

So they basically sign the anesthesia consent before r/b/a of anesthesia is actually explained to them, right? This is how they do it at my place as well.

Yes, you're correct.

What do you do when the anesthesia consent is signed already by a family member and on day of surgery, you can't get in touch with a family member and patient is an intubated icu patient?

Not sure I understand the question. It sounds like consent has already been obtained, so proceed to the OR.