1. 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.

5. 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

6. 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

7. 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

8. Risks Serious and frequent risks discussed in 98%
Documentation variable for:
Procedure specific risks
Additional procedures
18% of consent forms contained none

10. 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

20. 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

21. 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

22. Royal College of Obstetricians and Gynaecologists
Setting standards to improve women’s health
Risk Management and Medico-Legal Issues In Women’s Health
Joint RCOG/ENTER Meeting
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