1. 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

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

3. 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

4. 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

5. 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

6. 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

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

8. Number listed v Number Pre- consented
N= 64 PATIENTS

9. Grade of Clinician seeing patients

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

11. NICE COMPLIANCE
95% COMPLIANT 42 5 10 4 3

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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