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Are patients giving consent for their anaesthetic?

Are patients giving consent for their anaesthetic?. Background 1. DoH, Good practice in consent implementation guide: consent to examination or treatment. 2001. Open letter from the RCoA, Consent for care or treatment given by an anaesthetist. 2005.

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Are patients giving consent for their anaesthetic?

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  1. Are patients giving consent for their anaesthetic?

  2. Background 1 • DoH, Good practice in consent implementation guide: consent to examination or treatment. 2001. • Open letter from the RCoA, Consent for care or treatment given by an anaesthetist. 2005. • AAGBI, Consent for Anaesthesia Revised Edition. 2006. • BLT, Patient Information Leads Reference Guide. 2006.

  3. Background 2 Williams OA, Patient knowledge of operative care. Journal of the RSM. 1993. 86(6): 328-31. Study: 111pts Questionnaire prior to pre-op visit Information received & patient satisfaction Anaesthesia: 64% spoke to “nobody” beforehand 62% received no information 59% would have liked more Nurses (40%) most frequent providers

  4. Aims • Determine if pts spoke to “someone” about their anaesthetic before the day of their operation & who. • Determine if pts were given a patient information leaflet (PIL) before the day of their operation. • Determine if pts were offered an outpatient appointment (OPA) with an anaesthetist before the day of their operation. • To determine if pts wanted more information & by what means.

  5. Method 1 • Included all pts attending Barts Day Surgery Unit for 11 weekdays. • All pts were give a questionnaire when they reported to reception. • Asked to complete the questionnaire of their own accord while waiting for their pre-operative visit from their anaesthetist. • Asked to “post” all completed & uncompleted questionnaires into a red box. • The Day Surgery used register was used to confirm the number of pts included in the study.

  6. Questionnaire 1 • Date of operation & gender • Can you communicate easily in English? Y/N • If no, what is your preferred language? • Have you received an anaesthetic before? Y/N • Has someone spoken to you about your anaesthetic before today? Y/N • If yes, who? (Nurse, GP, Anaesthetist, Surgeon, Other)

  7. Questionnaire 2 • 7. Have you received a PIL about your anaesthetic before today? Y/N • 8. Were you offered an OPA with an anaesthetist before today? Y/N • 9. Would you have liked more information about your anaesthetic before today? Y/N • 10. If you answered yes, which would you prefer? (PIL, Web page address, OPA with an Anaesthetist)

  8. Results 1 • 158 pts: OMFS (7) Urology (9) Gynaecology (10) Plastics (7) Gen. Surgery (9) Vasc. Surgery (8) CR Surgery (10) Orthopaedics (22) Pain (25) STOP (43) ENT (3) Renal (3) • 97 completed questionnaires & 0 uncompleted. 40.2% male & 59.8% female. • 89% can communicate easily in English. Bengali (9), Spanish (2), Italian (1), Portuguese (1), Turkish (1) & Cantonese (1) • 68% previous experience of anaesthesia.

  9. Results 2 Somebody (65%) Nobody (35%) Nurses (27%) GPs (12.5%) Anaesthetists (12.5%) Surgeon (10%) Other (7%) 40% received a PIL 11% offered an OPA with an anaesthetist 39% wanted more information Of these: 46% (22) PIL 42% (20) OPA with an anaesthetist 12.5% (6) Web page address

  10. Discussion 1 73% received “some” information (PIL (12%) or discussion (45%) or both (42%) Compared to guidelines: 40% PIL Compared to previous data: Increased proportion had spoken to someone about their anaesthetic beforehand (35% vs 65%). The most frequent providers of information remain nurses (36% 10 vs 40%). Decreased proportion wanted more information about their anaesthetic before arriving (39% vs 59%).

  11. Discussion 2 • Can we improve on this? Yes • my “Gold Standard”: • Each pt that wants to should see his or her anaesthetist at an OPA • Each pt receives a PIL at this OPA. • More comprehensive information should be made available on anaesthetic web page on the new Trust website.

  12. Discussion 3 Each pt to see his or her anaesthetist as an OP. - Balanced against limited resources - At the moment targeted at higher risk - Can we offer an OPA with anaesthetist to those who want one Each pt to receive a PIL at OPA. - This can be at preadmission assessment clinic (PAC) - In-house/RCoA publication. ?budget available - Intimately linked with new Trust website An anaesthetic web page to be made available with more in depth information. - Distributing leaflets - Use audio/video formats/ local languages & larger print - Audit users who are accessing links - Relatively low cost & easy to maintain

  13. Study limitations • Unable to confirm that all patients included in the study were asked to complete the questionnaire. • Unable to ensure all forms were returned. • Unable to determine whether people were filling out the form correctly • Unable to confirm if pts with language barriers/communication difficulties were included.

  14. Recommendations 1 • All pts should receive a PIL at their PAC. • The PIL should contain at least all information recommended by the AAGBI. • The PIL should be an in-house publication & intimately linked to the new Trust website • A new anaesthesia web page that offers more in depth information.

  15. Recommendations 2 • Further study to see if we can offer an OPA with an anaesthetist to each pt that wants one or identify a pt a population who we could target this offer to. • Further audit to evaluate how well pts with language difficulties/barriers are informed about their anaesthetic.

  16. Acknowledgements For this study I would like to acknowledge help I received from: All the staff at the DSU who contributed to this work. I would also like to thank Dr Peter Saunders, Dr Mike Pead and Dr Simon Harrod for their assistance and discussions.

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