Audit on Consent to Anaesthesia

Abstract

Objective: To ensure a uniform approach to the taking of consent in line with Trust Policy and make recommendations to improve consenting for anaesthesia.Method: A list of all procedures who had an anaesthetic during one month was obtained. 50 cases were randomly selected from this list. Anaesthetic charts were assessed for consenting details.Results : Verbal consent to anaesthesia was documented in 74%.Written consent to anaesthesia for high risk patients was documented in 100%.Details of anaesthetic consent like anaesthetic techniques and risks were documented in 26% of anaesthetic records.Conclusion: The audit revealed incomplete documentation of anaesthetic consent in the anaesthetic records. The reasons were discussed and recommendations were suggested to improve or modify anaesthetic records and increase education and awareness among anaesthetists regarding documentation of risks and techniques. INTRODUCTION Patient has a fundamental right to know what he is undergoing and it is the duty of the anaesthetist taking care of the patient to provide the necessary information and seek an informed consent. The Association of Anaesthetists of Great Britain and Irelands ‘Information and Consent to Anaesthesia’ clearly explains the legal, professional and ethical responsibilities of the anaesthesit in providing information and obtaining consent. It is highly recommended to document the details of discussion between the patient and the anaesthetist. Documentation is an important feature of risk management in order to defend against claims of clinical negligence. Previous audits of consent have been undertaken in other medical disciplines but these did not address anaesthetic consent in any detail. As a result, the action plan from the last audit of consent stressed the need for a separate audit of anaesthetic consent to be undertaken. METHOD STANDARDS The standards selected were from the trust policy and they were: 1. 100% of patients should give either verbal or written consent to anaesthesia. 2. Written consent should be obtained in 100% of cases where anaesthesia represents a significant risk to the patient. 3. Where verbal consent is given, details of the discussion with and agreement of the patient (including details of the anaesthetic techniques, risks involved etc.) should be documented in the anaesthetic record. A list of all procedures during one month was obtained from information services and all procedures known to be performed without anaesthetic or using only local anaesthetic were removed. A sample was obtained by randomly selecting 50 cases from the list using a random number generator. Any cases that did not meet the inclusion criteria when reviewed were replaced with another randomly selected set of case notes. Data was collected and analysed with the assistance of the audit department. RESULTS Figure 1 A Trust ‘Consent to Anaesthesia’ form was found in only one case but verbal consent was documented on the anaesthetic record in a further 35 cases. In 1 case, there was documentation on the anaesthetic record, which confirmed that the patient was unable to consent. These cases all met Audit on Consent to Anaesthesia 2 of 4 standard one. In 13 cases no evidence was found to suggest that the patient had consented to anaesthesia. Figure 2 A significant anaesthetic risk was identified in only one case and this patient gave written consent to anaesthesia. Figure 3 The criterion regarding details of the anaesthetic technique was met if the checkbox ‘Technique explained’ on the anaesthetic record was ticked or if there were written details regarding anaesthetic technique in any notes made by the anaesthetist. Similarly for risks explained, there is a checkbox. The criterion regarding documentation of risks however, was only met if the risks of anaesthesia were listed in the anaesthetic notes/on the anaesthetic record The chart below shows the proportion of the 35 patients who gave verbal consent, in which each criterion was met. The last column of the chart shows the percentage of cases in which all 3 criteria were met. Figure 4 ADDITIONAL INFORMATION OBTAINED FROM THE AUDIT DOCUMENTATION OF TYPE OF ANAESTHESIA The intended type of anaesthesia was documented in 54% (27/50) of cases. Figure 5 GRADE OF ANAESTHETIST