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Audit on the Adequacy of Consenting Practices for Neck of Femur Fracture Surgeries

Introduction: Doctors are bound to obtain informed written consent prior to any form of surgical procedure on a patient. The General Medical Council (GMC) and the Royal College of Surgeons of England (RCS) provide guidance on what constitutes valid consent. Failure to obtain valid and adequate conse...

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Autores principales: Perera, Hector, Wusu, Adedoyin M, Mohammad, Alhashash, Qulaghassi, Mahdi Z, Adekola, Adekunle, Rao, Madhu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10653634/
https://www.ncbi.nlm.nih.gov/pubmed/38024031
http://dx.doi.org/10.7759/cureus.48565
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author Perera, Hector
Wusu, Adedoyin M
Mohammad, Alhashash
Qulaghassi, Mahdi Z
Adekola, Adekunle
Rao, Madhu
author_facet Perera, Hector
Wusu, Adedoyin M
Mohammad, Alhashash
Qulaghassi, Mahdi Z
Adekola, Adekunle
Rao, Madhu
author_sort Perera, Hector
collection PubMed
description Introduction: Doctors are bound to obtain informed written consent prior to any form of surgical procedure on a patient. The General Medical Council (GMC) and the Royal College of Surgeons of England (RCS) provide guidance on what constitutes valid consent. Failure to obtain valid and adequate consent can have legal ramifications. All relevant material risks associated with the surgery must be discussed with the patient during the consenting process. Materials and methods: This was a retrospective cross-sectional study of the consenting practices for neck of femur fracture surgeries, covering a period of three months, from the 15th of April to the 15th of July 2023. We evaluated the consent forms of 100 patients, of which 63 were consent form-1 and were included in the study. The British Orthopaedics Association (BOA)-endorsed consent forms, together with the RCS and GMC guidance on consent, which were used as the standard for the audit. Results: The majority of the consents were obtained by senior house officers (SHO) and core surgical trainees who did not have prior formal orthopaedic training (52.4%). The risks that were most frequently documented were infection, blood clots (deep vein thrombosis and pulmonary embolism), and bleeding, with documentation rates of over 90%. Prosthetic joint dislocation following hemiarthroplasty or total hip replacement was not mentioned in 22.2% of the forms. Neurovascular injury was not documented in 20.6% of the consent forms. Less than 75% documentation rates were observed for postoperative pain (74.6%), anesthetic complications (73%), failure (malunion/non-union/loosening of prosthesis) (68.3%), leg length discrepancy (60.3%), bone damage/fracture (50.8%), death (49.2%), wound-related complications/scars (42.9%), and hip stiffness (14.3%). None of the patients had been advised about the probable need for catheterization following surgery. We also noted that 22.2% (n=14) of the consent forms did not contain the diagnosis or the indication for surgery, 12.7% (n=8) did not mention the intended benefits, and 28.6% (n=18) of the consent forms had no mention of the responsible consultant. We also noted that in 25.4% (n=16) of the cases, the possible requirement of a blood transfusion had not been mentioned. Conclusion: The audit revealed several deficiencies in the consenting of patients for neck and femur fracture surgeries. There were poor documentation rates for risks associated with surgery, especially the less common and rare ones. We also identified several deficiencies in the remaining aspects of the consent forms that were not in keeping with the GMC and RCS guidance on consent. The lack of orthopaedic training and knowledge among the senior house officers and core trainees may be a contributing factor.
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spelling pubmed-106536342023-11-09 Audit on the Adequacy of Consenting Practices for Neck of Femur Fracture Surgeries Perera, Hector Wusu, Adedoyin M Mohammad, Alhashash Qulaghassi, Mahdi Z Adekola, Adekunle Rao, Madhu Cureus Orthopedics Introduction: Doctors are bound to obtain informed written consent prior to any form of surgical procedure on a patient. The General Medical Council (GMC) and the Royal College of Surgeons of England (RCS) provide guidance on what constitutes valid consent. Failure to obtain valid and adequate consent can have legal ramifications. All relevant material risks associated with the surgery must be discussed with the patient during the consenting process. Materials and methods: This was a retrospective cross-sectional study of the consenting practices for neck of femur fracture surgeries, covering a period of three months, from the 15th of April to the 15th of July 2023. We evaluated the consent forms of 100 patients, of which 63 were consent form-1 and were included in the study. The British Orthopaedics Association (BOA)-endorsed consent forms, together with the RCS and GMC guidance on consent, which were used as the standard for the audit. Results: The majority of the consents were obtained by senior house officers (SHO) and core surgical trainees who did not have prior formal orthopaedic training (52.4%). The risks that were most frequently documented were infection, blood clots (deep vein thrombosis and pulmonary embolism), and bleeding, with documentation rates of over 90%. Prosthetic joint dislocation following hemiarthroplasty or total hip replacement was not mentioned in 22.2% of the forms. Neurovascular injury was not documented in 20.6% of the consent forms. Less than 75% documentation rates were observed for postoperative pain (74.6%), anesthetic complications (73%), failure (malunion/non-union/loosening of prosthesis) (68.3%), leg length discrepancy (60.3%), bone damage/fracture (50.8%), death (49.2%), wound-related complications/scars (42.9%), and hip stiffness (14.3%). None of the patients had been advised about the probable need for catheterization following surgery. We also noted that 22.2% (n=14) of the consent forms did not contain the diagnosis or the indication for surgery, 12.7% (n=8) did not mention the intended benefits, and 28.6% (n=18) of the consent forms had no mention of the responsible consultant. We also noted that in 25.4% (n=16) of the cases, the possible requirement of a blood transfusion had not been mentioned. Conclusion: The audit revealed several deficiencies in the consenting of patients for neck and femur fracture surgeries. There were poor documentation rates for risks associated with surgery, especially the less common and rare ones. We also identified several deficiencies in the remaining aspects of the consent forms that were not in keeping with the GMC and RCS guidance on consent. The lack of orthopaedic training and knowledge among the senior house officers and core trainees may be a contributing factor. Cureus 2023-11-09 /pmc/articles/PMC10653634/ /pubmed/38024031 http://dx.doi.org/10.7759/cureus.48565 Text en Copyright © 2023, Perera et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Orthopedics
Perera, Hector
Wusu, Adedoyin M
Mohammad, Alhashash
Qulaghassi, Mahdi Z
Adekola, Adekunle
Rao, Madhu
Audit on the Adequacy of Consenting Practices for Neck of Femur Fracture Surgeries
title Audit on the Adequacy of Consenting Practices for Neck of Femur Fracture Surgeries
title_full Audit on the Adequacy of Consenting Practices for Neck of Femur Fracture Surgeries
title_fullStr Audit on the Adequacy of Consenting Practices for Neck of Femur Fracture Surgeries
title_full_unstemmed Audit on the Adequacy of Consenting Practices for Neck of Femur Fracture Surgeries
title_short Audit on the Adequacy of Consenting Practices for Neck of Femur Fracture Surgeries
title_sort audit on the adequacy of consenting practices for neck of femur fracture surgeries
topic Orthopedics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10653634/
https://www.ncbi.nlm.nih.gov/pubmed/38024031
http://dx.doi.org/10.7759/cureus.48565
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