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29 July 2008 - Brisbane

Audit of the Process of Informed Consent for Primary Elective LSCS Presenter: Anne-Maree Pollard Hospital: Cougar 3 A.Pollard@sdmh.org.au. 29 July 2008 - Brisbane. KEY AREA OF INTEREST. With clients undergoing primary LSCS: who was making the decision for LSCS why was it being done

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29 July 2008 - Brisbane

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  1. Audit of the Process of Informed Consent for Primary Elective LSCSPresenter: Anne-Maree PollardHospital: Cougar 3A.Pollard@sdmh.org.au 29 July 2008 - Brisbane

  2. KEY AREA OF INTEREST • With clients undergoing primary LSCS: • who was making the decision for LSCS • why was it being done • at what gestation was it being decided • when was the consent obtained • who was consenting the client

  3. AIM OF THIS AUDIT • Confirm that appropriate senior staff were involved in the decision to perform LSCS • Look at the common reasons for primary LSCS and consider the appropriateness of the decision • Look for documented evidence of the discussion of risk factors when consenting the clients for LSCS • Note when the consent was obtained by comparing the date of decision to operate and the date written on the consent

  4. Process of Audit • All primary elective LSCS files from July2007 to December 2007 were audited • When decision was made to LSCS • Who made decision • When consent was obtained and by who • Were the risk factors around LSCS documented • Reason for LSCS • Age of clients at LSCS

  5. Results of Audit • 23 medical records were audited • 13primiparous/10 multiparous clients • 6 clients were private patients (26%) • Average age 30.6 years • All decisions made by consultant or senior registrar • Average gestation age of decision 29.5/40 • 78% of clients were consented on the day of the LSCS

  6. RESULTS OF AUDIT cont • Reasons for LSCS: • 26% Previous difficult delivery • 17% Breech • 13% Client request • 13% Placenta previa • 9% Past history of myomectomy • 9% High head at term • 4% Macrosomia • 4% Twins • 4% Past history FDIU • 3 distinct groups of Drs were recognised as signing the consent form • Consultant/Senior registrar 10% • GP Obstetrician 5% • Resident 75% • Of the 3 groups: • Residents documented the risk of LSCS in 90% of cases • GP/Obs 50% • Consultant/Senior reg 10%

  7. EVALUATION OF AUDIT • Private clients made up 26% of the audited records, the hospital average for private clients is around 4% • Though the decision to perform LSCS was made on average around 29.5/40 weeks, 78% of clients were consented on the day of the LSCS • Reasons for LSCS were varied and difficult to assess based on the limited scope of the audit • The more senior the staff the less likely it was that the documentation of risks discussed around the LSCS were written in the medical record

  8. CONCLUSION & ACTION • Senior medical staff will need to review their writing of risk discussion for LSCS (as per the Guideline for consent) and improve documentation • At the time of deciding to deliver by LSCS, document discussion of risks in the medical record • Present data to next Obstetrics and Gynaecology meeting • Consider a template with prompts for discussion regarding risk factors around LSCS

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