An Audit On Informed Consent Fulfilment Process Mohd Afiq Mohd Slim Feargal Cadden Michael Mullan Seamus Dolan

Background Complex process When not to give Patient wish Necessity Knowing will cause more harm

Montgomery Ruling March 2015 Bolam test is out! The Test of Materiality “reasonable care to ensure that the patient is aware of any material risks involved in any recommended treatment, and of any reasonable alternative or variant treatments” ‘Material risk’ “A risk to which a reasonable person in the patient’s position would be likely to attach significance or a risk that a doctor knowns, or should reasonably know” Time….time….time! “even those less skill or inclination for communication will be obliged to pause and engage in the discussion which the law requires” What is a bolum test: if a doctor conduct is supported by a responsible body/medical body opinion, then that option is valid Problem with Montgomery here 1. Need to gauge patient’s ‘importance’, what is important to them might not be important to us eg bus drive or lorry driver post perianal abscess I&D, cannot sit, cannot drive, cannot earn OR young beautiful lady, bikini model, have umbilical hernia now belly button gone post-op

Aim To assess the amount of information given to the patient for a valid informed consent process

Standard Royal College of Surgeons of England, Good Surgical Practice 2014

Methods 1-1 survey Only elective cases Aug-Sep All consultants Likert scales for rating questions Only elective cases Cholecystectomy Hernia Inguinal Umbilical

Risk Explanation Score Results: Overview Type of Operation Sample Size (n) Survey score (%) Risk Explanation Score Cholecystectomy 10 68.43 9.2 Hernia 58.14 8.7 N asked=21 patients, 1 say no, so only 20 Overall survey score=63.29% Overall risk=8.95 (likert, 10 good, 1 bad)

RCS England Standard=73.57 Chole=72.85% Hernia=74.29%

Extra Part here=53% Chole=64% Hernia=42% Sign at OPD-1 chole, 4 hernia, Hernia don’t have information leaflet Majority got consented at OPD, no copy of form given, majority sign on admission

Conclusion Suggestions We are good but we can be better! Information leaflet for Inguinal hernia Umbilical hernia Continue consenting in OPD Give a copy of consent form to patient Impact of surgery on patient’s life To inform patient regarding other possible surgeons