Consent for Common Obstetric and Gynaecological Procedures

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Consent for Common Obstetric and Gynaecological
Procedures

• Presented by Dr Stella Mwenechanya
• Calderdale and Huddersfield NHS Trust

2
Aims and objectives

• Compliance of current practice to GMC/RCOG
  advice
• Looking at process, documentation
• More specifically
• Who is taking consent
• Serious and frequent risks documented.

3
Background and Standards

• Legal document
• may help reduce complaints/litigation
• GMC informed consent
• By investigator/operator
• Delegation to suitably qualified and trained
  person
• Sufficient knowledge of procedure and risks

4
Standards

• RCOG consent advice given on several gynae
  procedures and C/S
• Based on DOH/welsh assembly consent form 1
• Advice on risks to be discussed for each
  procedure also given.

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Method

• Retrospective review of cases July and August
  2007
• August new SHO intake
• July SHOs in post atleast 4 months
•  Theatre Registers
• Procedures looked at were
• Abdominal hysterectomy for heavy periods
• Caesarean section
• Diagnostic hysteroscopy
• Diagnostic laparoscopy
• Laparoscopic tubal occlusion
• Pelvic floor repair and vaginal hysterectomy for
  prolapse

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Information looked at

• Patient identification
• Name and benefits of procedure
• Serious and frequently occurring risks
• Extra procedures to/not to be carried out
• Leaflet
• Anaesthetic

• Health professional completing the form compared
  to performing the procedure and their competency
• Patient signature
• Confirmation of consent

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Results

• 57 cases analysed. (10 C/S)
• 100 compliance in
• Patients surname, first name, DOB and NHS/hosp
  number
• Name of procedure
• appropriate benefits
• 28(16) named consultant

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Risks

• Serious and frequent risks discussed in 98
• Documentation variable for
• Procedure specific risks
• Additional procedures
• 18 of consent forms contained none

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Abdominal Hysterectomy
11
Caesarean Section
12
Diagnostic Hysteroscopy
13
Diagnostic Laparoscopy
14
Laparoscopic Tubal Occlusion
15
Pelvic Floor Repair Vaginal Hysterectomy
16
Leaflet/Anaesthetic

• 32(18) Leaflet
• 79(45) type of anaesthetic ticked

17
Doctor Signature/Date/Name/Position

• 96(55) Signed and Dated
• 93 Printed name (legible)
• 19 were complete by consultants
• 21 by associate specialists
• 46 by registrars
• 7 by SHOs
• 43(25) completed by the health professional
  performing the procedure

18
Competency

• 94(54) competent to perform the procedure
• 3 VTS SHOs
• 2 c-section
• 1 diagnostic laparoscopy

19
Patient Signature/Date/Name

• 96(54) Signed
• 84 Dated
• 68 Name printed

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Conclusion

• Good compliance with guidelines on documentation
  of
• patient/procedure details
• Procedure benefits
• Person obtaining consent
• Serious and frequent risks
• Reasonable compliance with local guidelines
• Poor compliance with RCOG
• Compliance also to be improved in
• Leaflets provision/documentation
• Anaesthetic discussion
• Named consultant

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Recommendations

• Use of procedure specific consent forms to ensure
  all risks discussed with patient.
• May even reduce repeat C/S rate
• Registrar Inductions to include guidelines in
  obtaining valid consent.
• Audit of local risks for each procedure.
• Re-audit in 3years

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Royal College ofObstetricians andGynaecologists
Setting standards to improve womens health
Risk Management and Medico-Legal Issues In
Womens Health Joint RCOG/ENTER Meeting
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