Consents for Injections?

[Steveington]

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For surgeries and procedures such as a matrixectomy, I think we all should get a written consent from the patient.
But for a steroid injection, do you get a written consent?

 

[HardRoadPaved]

For surgeries and procedures such as a matrixectomy, I think we all should get a written consent from the patient.
But for a steroid injection, do you get a written consent?

Not on my end. Since it is a "drug" I just look at it as medication through just a different delivery mechanism. I think if you give the patient quick talk about steroid flares and set realistic expectations you'll be fine.

Of course for more permanent surgeries where a deformity, reoccurrence, infection is more likely, a consent is warranted

 

[PeaJay]

It is considered a procedure by the joint commission and requires full consent and documentation of universal protocol.

This is technically for anything billed as a procedure albeit I do not do it for nails/callus.

 

[dtrack22]

It is considered a procedure by the joint commission

the joint commission has no regulatory authority over 99% of us in clinic.

Neither myself nor the orthos in our clinic get written consent for injections.

 

[DYK343]

They make me get a consent to cut a callus around here.
Its ridiculous.
My MAs have that done for me before I walk in the room but its one more thing I have to remember to check to make sure it was done.

 

[air bud]

They make me get a consent to cut a callus around here.
Its ridiculous.
My MAs have that done for me before I walk in the room but its one more thing I have to remember to check to make sure it was done.

Lol

 

[heybrother]

If a patient's mummified toe falls off do you consent for it? (And do you bill it?)

Remember, there is no global. 😉

 

[PeaJay]

the joint commission has no regulatory authority over 99% of us in clinic.

Neither myself nor the orthos in our clinic get written consent for injections.

I wish that was the case for me. My group is on use hard to consent for just about everything due to joint commission standards.

 

[619]

For surgeries and procedures such as a matrixectomy, I think we all should get a written consent from the patient.
But for a steroid injection, do you get a written consent?

I get written consent for matrixectomy, Avulsion, granuloma excision, foreign body removal, office I&D, Ganglion cysts aspiration (I inject steroid afterwards), any rare(weird) office procedures.

But I do not for plantar fasciitis injection, Neuroma, joint injection, tendinitis etc.

 

[deleted285117]

I get written consent for matrixectomy, Avulsion, granuloma excision, foreign body removal, office I&D, Ganglion cysts aspiration (I inject steroid afterwards), any rare(weird) office procedures.

But I do not for plantar fasciitis injection, Neuroma, joint injection, tendinitis etc

Same here 100%

 

[DYK343]

There is a quality control/risk mitigation nurse that comes through the clinic about every 4-6 weeks.

EVERYTIME she comes she makes documentation more time consuming.

I never had to consent for nail debridement or callus but she decided I do as of 6 months ago.

Anesthetize a toe? I have to document lidocaine in 3 separate places (2x in chart, 1x paper log) because its now just the way it is. Lot number and all 3x. MAs are not allowed to document lot number. Must be doctor. A cortisone cocktail is a nightmare documentation wise.

If I draw lidocaine in front of patient out of the bottle and immediately inject I still have to write 1% lidocaine on the syringe (made them buy me stickers).

Put a single use packet bacitracin on a small wound with a bandaide? Bacitracin Lot number and expiration date must be documented by me.

Its just a pain and honestly affects what I do in a negative way. I hate it. We run on joint commission standards here too. Be thankful you dont have to follow their ridiculous rules.

 

[PeaJay]

There is a quality control/risk mitigation nurse that comes through the clinic about every 4-6 weeks.

EVERYTIME she comes she makes documentation more time consuming.

I never had to consent for nail debridement or callus but she decided I do as of 6 months ago.

Anesthetize a toe? I have to document lidocaine in 3 separate places (2x in chart, 1x paper log) because its now just the way it is. Lot number and all 3x. MAs are not allowed to document lot number. Must be doctor. A cortisone cocktail is a nightmare documentation wise.

If I draw lidocaine in front of patient out of the bottle and immediately inject I still have to write 1% lidocaine on the syringe (made them buy me stickers).

Put a single use packet bacitracin on a small wound with a bandaide? Bacitracin Lot number and expiration date must be documented by me.

Its just a pain and honestly affects what I do in a negative way. I hate it. We run on joint commission standards here too. Be thankful you dont have to follow their ridiculous rules.

I feel your pain. Nearly same stuff I have to deal with. And they wonder why I am not as productive as my peers on the mgma

 

[air bud]

Yeah my old MSG job had to document lot number and NDC etc. Fortunately could save in system and never changed.

I don't even get for nail removals now but I know I should. Will start soon.

 

[air bud]

There is a quality control/risk mitigation nurse that comes through the clinic about every 4-6 weeks.

EVERYTIME she comes she makes documentation more time consuming.

I never had to consent for nail debridement or callus but she decided I do as of 6 months ago.

Anesthetize a toe? I have to document lidocaine in 3 separate places (2x in chart, 1x paper log) because its now just the way it is. Lot number and all 3x. MAs are not allowed to document lot number. Must be doctor. A cortisone cocktail is a nightmare documentation wise.

If I draw lidocaine in front of patient out of the bottle and immediately inject I still have to write 1% lidocaine on the syringe (made them buy me stickers).

Put a single use packet bacitracin on a small wound with a bandaide? Bacitracin Lot number and expiration date must be documented by me.

Its just a pain and honestly affects what I do in a negative way. I hate it. We run on joint commission standards here too. Be thankful you dont have to follow their ridiculous rules.

Holy crap. I guess I won't get annoyed that we can't draw up injection even the day of.

 

[dtrack22]

There is a quality control/risk mitigation nurse that comes through the clinic about every 4-6 weeks.

I found the problem…

 

[dtrack22]

Also, I don’t get written consent for any nail procedures in clinic. Including matrixectomies. I explain to the patient the procedure, what they will feel afterwards, what it will look like, and they come back in two weeks having experienced everything just like I said they would. I document these things and the patient’s consent in my note. I’ve never even come close to having a complication with any toenail procedure that could become litigious. I don’t even think that’s possible. We aren’t doing brain surgery here. It’s ingrown toenails, and cantharone treatments, and steroid injections, and ganglion ASPIRATIONS…not even excisions…

Long story short, nobody should listen to me about written consent forms.

 

[msuDPM]

There is a quality control/risk mitigation nurse that comes through the clinic about every 4-6 weeks.

EVERYTIME she comes she makes documentation more time consuming.

I never had to consent for nail debridement or callus but she decided I do as of 6 months ago.

Anesthetize a toe? I have to document lidocaine in 3 separate places (2x in chart, 1x paper log) because its now just the way it is. Lot number and all 3x. MAs are not allowed to document lot number. Must be doctor. A cortisone cocktail is a nightmare documentation wise.

If I draw lidocaine in front of patient out of the bottle and immediately inject I still have to write 1% lidocaine on the syringe (made them buy me stickers).

Put a single use packet bacitracin on a small wound with a bandaide? Bacitracin Lot number and expiration date must be documented by me.

Its just a pain and honestly affects what I do in a negative way. I hate it. We run on joint commission standards here too. Be thankful you dont have to follow their ridiculous rules.

Wow. You have awesome patience. I honestly think I would quit if those practices were firmly upheld. Such a drain on efficiency/productivity.

We consent for all injections, nail avulsions, tenotomies, biopsies, etc but I just have to sign all the consents at the end of the day.

NDCs/lot #s are required on injections, but the MAs enter all that and I don't have to deal with it.

We've had some silly compliance/safety rules added, like they stopped allowing unsterile gauze cannisters on the counter and required locks on all the treatment room cabinetry. I simply have the MAs unlock all of them first thing in the morning and lock them after clinic..

They once tried to implement verbal "time outs" before every office procedure, injection, etc. I vehemently refused and explain how stupid of an idea it was...never heard of it again....so I guess my hospital is somewhere in the middle regarding silly safety/compliance rules

 

[Feli]

I don't think consent is necessary for anything unless it's OR, sedation/general (ie ER fracture reduction or major procedure with sed), or if it's a minor/incompetent pt who can't give consent. We are one of the only specialties that does written consents for straight local procedures... plastics, derm, ENT barely ever do them, and a lot of their procedures are more invasive and bloody and expensive than ours. Podiatry is very timid by comparison.

A steroid inject? Huh? That must be some kind of joke. If someone came near my knee, shoulder, etc and started cleaning the skin and brandishing a syringe, I would just say "whoa wtf" if I wasn't on the same page. I think consent is pretty much implied (and documented in EMR already). Consent does not have to be written, and there has to be some element of common sense in the mix. You have to make it somewhat efficient, and consents just for the sake of security blanket makes for not only more wasted doc time but also more scanning, more filing, more liability due to half-filled consent forms or incorrect laterality, etc.

Even for wounds, ingrown, foreign body, minor I&D blister or pustule, etc... I only do paper consents if the facility absolutely requires them. No need in the private office imo... the patient is right there watching you do it and knows perfectly well what's going on. I know I'm probably the miniority and most DPMs consent their verruca, wounds, etc to be "safe." What's next, consents for casting? 😆 We are fickle folk 🙁

For ... procedures such as a matrixectomy, I think we all should get a written consent from the patient.

Why? Billing? Legal? Patient expects it? Most DPMs do it? "To be safe?" Facility/employer requires it?... really though: why should we get it? No joke.

...I don't even get for nail removals now but I know I should. Will start soon.

Why? Don't give in to the cowardly ways! Be a disciple of common sense 😎

They make me get a consent to cut a callus around here.
Its ridiculous.
My MAs have that done for me before I walk in the room but its one more thing I have to remember to check to make sure it was done.

That is 100% insane... time from your life you'll never get back.

Also, I don’t get written consent for any nail procedures in clinic. Including matrixectomies. I explain to the patient the procedure, what they will feel afterwards, what it will look like, and they come back in two weeks having experienced everything just like I said they would. I document these things and the patient’s consent in my note. I’ve never even come close to having a complication with any toenail procedure that could become litigious. I don’t even think that’s possible. We aren’t doing brain surgery here. It’s ingrown toenails, and cantharone treatments, and steroid injections, and ganglion ASPIRATIONS…not even excisions…

Long story short, nobody should listen to me about written consent forms.

Whew... this is the way is should be... and I had to read down to nearly the thread to find it. Amen.
Use the time you'd waste with consent just communicating well with the patient and starting it already 🙂

 

[DYK343]

I am pretty sure VAs are super consent heavy. Or at least the ones I visited/rotated at as a student. Maybe someone with better experience can chime in but I think nails, calluses, etc require a consent?

I think with time it will be the norm everywhere. We dont like it and it slows us down but every year documentation goes up and reimbursements go down.

 

[Feli]

I am pretty sure VAs are super consent heavy. Or at least the ones I visited/rotated at as a student. Maybe someone with better experience can chime in but I think nails, calluses, etc require a consent?

I think with time it will be the norm everywhere. We dont like it and it slows us down but every year documentation goes up and reimbursements go down.

Oh, it is the norm in govt programs with more site visits and paperwork pushers than patients entering the buildings each day.

I certainly don't think it will ever be the norm in efficient profitable places like private hospitals, PP, MSG, etc, though. You have just been observing within the govt bubble of missed revenues and gross inefficiency.

In the IHS facility I'm at, they want consent for basic wounds, ingrown, injects, FB, etc... thankfully not yet for verruca or nails or calluses. We get weekly - sometimes daily - visits from the med rec ppl or coders with a folder of consents (some months and months old) where we got the date wrong, pt or doc or witness signed in wrong place, laterality didn't match the note, alternatives (to neuroma inject!?!?!?!) line left blank, etc etc etc. Most of us have basically stopped doing the consents on busy clinic days and at ER or inpt bedside when it's difficult. The hilarious part is the coders and med records staff tell us "well it won't get billed" if the consent isn't done and done correctly on all lines... as if we care, we're on salary! That is their choice if they want to cost the facility hundreds of dollars since the patient signed the guardian line or put the wrong date. Sore subject I guess... the inefficiency drives me craaazy, and I am counting the days, lol. ✌️

 

[Utvolsdpm]

Also, I don’t get written consent for any nail procedures in clinic. Including matrixectomies. I explain to the patient the procedure, what they will feel afterwards, what it will look like, and they come back in two weeks having experienced everything just like I said they would. I document these things and the patient’s consent in my note. I’ve never even come close to having a complication with any toenail procedure that could become litigious. I don’t even think that’s possible. We aren’t doing brain surgery here. It’s ingrown toenails, and cantharone treatments, and steroid injections, and ganglion ASPIRATIONS…not even excisions…

Long story short, nobody should listen to me about written consent forms.

I know you probably mean it’s near impossible to have a complication on young healthy folks or in general if you even briefly examine your patients. But I have seen other practitioners do ingrowns that turn in to first ray amps (and also bunions as well). Consents for nail procedures are annoying but never a bad idea. I’m not a fan of consent for injections however.

 

[DYK343]

Oh, it is the norm in govt programs with more site visits and paperwork pushers than patients entering the buildings each day.

I certainly don't think it will ever be the norm in efficient profitable places like private hospitals, PP, MSG, etc, though. You have just been observing within the govt bubble of missed revenues and gross inefficiency.

In the IHS facility I'm at, they want consent for basic wounds, ingrown, injects, FB, etc... thankfully not yet for verruca or nails or calluses. We get weekly - sometimes daily - visits from the med rec ppl or coders with a folder of consents (some months and months old) where we got the date wrong, pt or doc or witness signed in wrong place, laterality didn't match the note, alternatives (to neuroma inject!?!?!?!) line left blank, etc etc etc. Most of us have basically stopped doing the consents on busy clinic days and at ER or inpt bedside when it's difficult. The hilarious part is the coders and med records staff tell us "well it won't get billed" if the consent isn't done and done correctly on all lines... as if we care, we're on salary! That is their choice if they want to cost the facility hundreds of dollars since the patient signed the guardian line or put the wrong date. Sore subject I guess... the inefficiency drives me craaazy, and I am counting the days, lol. ✌️

My staff got in trouble today by management because I forgot to document silver nitrate on a wound debridement. It was my fault. Not theirs. But they took the blame. They weren't in the room. I used the stick and disposed of it. Its so dumb and so annyoing. End of the day count did not match up. You heard that correctly. End of the day silver nitrate stick count. Yep. Its a thing.

Well I hope youre correct about it not becoming the norm everywhere. I really hope you are. There is this thing called lawyers tho. All it takes is 1 incident down in arkansas and the whole country now has to obide (somewhat exaggeration but you get my point).

 

[DYK343]

I know you probably mean it’s near impossible to have a complication on young healthy folks or in general if you even briefly examine your patients. But I have seen other practitioners do ingrowns that turn in to first ray amps (and also bunions as well). Consents for nail procedures are annoying but never a bad idea. I’m not a fan of consent for injections however.

Until that plantar fascial band ruptures!

 

[dtrack22]

Consent does not have to be written

This is 100% true

But I have seen other practitioners do ingrowns that turn in to first ray amps

If you do a matrixectomy and it ends up in a first ray you either a) were negligent or b) understood the risk, explained your concerns or the risk to the patient, and they said “yes, I want to do it,” and all of that is documented in your note. Patient won’t have a leg to stand on in court (pun intended).

for those who have a matrixectomy consent in clinic, does it spell out amputation as a risk? If so do you read that to every patient? If not, then your consent doesn’t actually protect you from a litigious patient who had a bad outcome. I haven’t even had a matrixectomy that required some sort of local wound care because it didn’t heal. I don’t do matrixectomies on turds I guess. They generally don’t need it anyways, those types of folks you can just trim the nail back every 3 months since they are clearly enough of a vasculopath to qualify for routine foot care.

Written consent is just not the savior that many people assume. Hell, James Andrews was sued for nearly $200 million because of a written consent form. The consent will lead to his malpractice carrier settling, not protect him…

 

[Scrantonicity]

My staff got in trouble today by management because I forgot to document silver nitrate on a wound debridement. It was my fault. Not theirs. But they took the blame. They weren't in the room. I used the stick and disposed of it. Its so dumb and so annyoing. End of the day count did not match up. You heard that correctly. End of the day silver nitrate stick count. Yep. Its a thing.

Well I hope youre correct about it not becoming the norm everywhere. I really hope you are. There is this thing called lawyers tho. All it takes is 1 incident down in arkansas and the whole country now has to obide (somewhat exaggeration but you get my point).

Silver nitrate count??? Dude...I sincerely hope you are making a big enough salary to justify working at this place. I hope they also measure the use of Ethyl Chloride spray for injections. I can see them using a ruler to measure the fluid line at the end of the day...

 

[DYK343]

Silver nitrate count??? Dude...I sincerely hope you are making a big enough salary to justify working at this place. I hope they also measure the use of Ethyl Chloride spray for injections. I can see them using a ruler to measure the fluid line at the end of the day...

I do make pretty good cash here. Thats why I stay. It never used to be this way. Joint commission came through about a year ago and afterwards its just gotten out of control documentation wise. Its not penny pinching. Its book keeping and all directed by that new risk assessment nurse (not sure what her actual title is). they hired to come through and tidy up the documentation.

 

[HardRoadPaved]

I do make pretty good cash here. Thats why I stay. It never used to be this way. Joint commission came through about a year ago and afterwards its just gotten out of control documentation wise. Its not penny pinching. Its book keeping and all directed by that new risk assessment nurse (not sure what her actual title is). they hired to come through and tidy up the documentation.

Sounds exactly like they are controlling theft and limiting product usage through the guise of documentation.

 

[Scrantonicity]

Sounds exactly like they are controlling theft and limiting product usage through the guise of documentation.

True. Prisons are getting overcrowded with silver nitrate thieves. Hard to blame them, what with the insane rates in the black market for silver nitrate sticks. Guess I'll start counting, too.

 

[DYK343]

That nurse is here right now. Shes coming by more frequently. Shes digging.

They count the lidocaine, bacitracin packets, cortisone, silver nitrate, etc, etc and balance them against the books to make sure everything was documented and something wasnt missed. its ridiculous.

 

[Pronation]

That nurse is here right now. Shes coming by more frequently. Shes digging.

They count the lidocaine, bacitracin packets, cortisone, silver nitrate, etc, etc and balance them against the books to make sure everything was documented and something wasnt missed. its ridiculous.

I would start smothering entire feet using baci packets. Start blowing through dozens per patient.

 

[air bud]

That nurse is here right now. Shes coming by more frequently. Shes digging.

They count the lidocaine, bacitracin packets, cortisone, silver nitrate, etc, etc and balance them against the books to make sure everything was documented and something wasnt missed. its ridiculous.

Holy crap. Did a PE firm buy your clinic out?