Audit into Trust Policy on pre-consent and NICE guideline compliance for third molar surgery Graham McElligott BDS(Hons) FDSRCS(Eng) FHEA Specialty Doctor grade in Oral Surgery

AIMS To record how many patients are pre-consented at the consultation stage To see what reasons are given for third molar removal

OBJECTIVES To demonstrate how we are doing in complying with trust policy on Pre-consent. To demonstrate whether or not we are in compliance with NICE guidelines for third molar surgery

WHY PRE-CONSENT It is the policy of this trust to do so The department of health strongly advises it to be done So does the Royal College of Surgeons So do the defence organisations. It is good practice

Data collection method I compiled data prospectively each time I did a daycase list at ECC Aintree, looking only at patients listed for third molar surgery

Number of patients listed 19 different clinicians of various grades working in 3 units, listed 64 patients Unit A listed 29 patients Unit B listed 24 patients Unit C listed 11 patients

PERCENTAGE OF PATIENTS CONTRBUTED TO AUDIT BY UNIT 17% 45% 38%

Number listed v Number Pre- consented N= 64 PATIENTS

Grade of Clinician seeing patients

In total 21/64 patients listed were pre-consented This is 32.8%

NICE COMPLIANCE 95% COMPLIANT 42 5 10 4 3

IMPLICATIONS Some clinicians do not seem to be completing the consent process– Why? Slows down daycase clerking May delay list start times May result in patient cancellation Are SHOs having enough involvement with dentoalveolar planning We do comply with Nice Guidelines

WHEN SHOULD WRITTEN CONSENT BE TAKEN? There is no law on this The law in England recommends clinicians to be familiar with local trust policy UHA trust policy is that written consent must be obtained in advance of an elective procedure This policy extends to spoke units listing patients here

When should consent be taken? “patients receiving elective treatment for which written consent is appropriate should be familiar with the contents of their consent form before they arrive for the actual procedure, and should have received a copy of the page documenting the decision-making process” Source Department of Health Good practice in the implementation of consent guide The above statement is incompatible with single stage consent on the day of treatment

When considering routine procedures being undertaken under general anaesthesia, it is undesirable for the consent process to be undertaken immediately before the procedure is due to be performed. The difficulty in this situation is that a patient’s decision to consent to treatment may be seen to be affected by anxiety regarding the proposed treatment A patient may feel committed to proceeding with treatment under general anaesthesia and not have the opportunity to weigh up the potential risks and make a valid decision regarding whether they would wish to proceed. Source Yvonne Shaw LLM BchD DPDS Dento-legal advisor Dental Protection society

In the event an adverse outcome did arise following a procedure being undertaken, a clinician may have some difficulty demonstrating that the patient had been given sufficient opportunity to consider the relevant information and that consent was freely given. Source Yvonne Shaw LLM BchD DPDS Dento-legal advisor Dental Protection society

If an out-patient consultation results in a (joint) decision to operate, the consent process must (ipso facto) be complete. The consent form must therefore be completed at that stage In brief; all patients should be consented prior to listing. The consent process should be documented contemporaneously (which is what the consent form is for). Source Bruce Pennie Surgical Directorate Manager