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Informed consent for surgery on neck of femur fractures: A multi-loop clinical audit

BACKGROUND: The Montgomery case in 2015 resulted in a pivotal change in practice, leading to a patient-centric approach for informed consent. Neck of femur (NOF) fractures are associated with a high rates perioperative morbidity and mortality. Using guidelines highlighted by the British Orthopaedic...

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Autores principales: Shah, Rohi, Sambhwani, Sharan, Al-Shahwani, Awf, Plakogiannis, Christos
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7242500/
https://www.ncbi.nlm.nih.gov/pubmed/32461800
http://dx.doi.org/10.1016/j.amsu.2020.03.008
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author Shah, Rohi
Sambhwani, Sharan
Al-Shahwani, Awf
Plakogiannis, Christos
author_facet Shah, Rohi
Sambhwani, Sharan
Al-Shahwani, Awf
Plakogiannis, Christos
author_sort Shah, Rohi
collection PubMed
description BACKGROUND: The Montgomery case in 2015 resulted in a pivotal change in practice, leading to a patient-centric approach for informed consent. Neck of femur (NOF) fractures are associated with a high rates perioperative morbidity and mortality. Using guidelines highlighted by the British Orthopaedic Association we performed a multi-loop audit within our department to assess the adequacy of informed consent for NOF fractures. METHODS: Two prior cycles had been performed utilising a similar framework. Prior interventions included ward posters, verbal dissemination of information at Junior Doctor's (JD) induction and amendments to the JD handbook. For the latest audit loop, a retrospective analysis of 100 patients was performed. Risk were classified as common, less common, rare and ‘other’ non-classifiable risks. The adequacy of informed consent was evaluated by assessing the quality and accuracy of documentation in the signed Consent Form-1s for compos mentis patients. RESULTS: Infection, bleeding risks, clots and anaesthetic risks were documented in all patients (100%). Areas of improvement included documentation of neurovascular injuries (98%), pain (75%) and altered wound healing (69%). There was no significant change in the documentation of failure of surgery (83%) and neurovascular injuries (98%). Poorly documented risk factors included mortality (21%), prosthetic dislocation (14%) and limb length discrepancy (6%). CONCLUSION: Following the latest cycle, the trust has now approved the use of 2 consent-specific stickers (for arthroplasty or fixation), amendable on a patient-to-patient basis. As part of the multi-loop process, the cycle will be repeated every year, in line with Junior Doctor rotations. Medical professionals have an ethical, moral and legal obligation to ensure they provide all information regarding surgical interventions to aid patients in making an informed decision.
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spelling pubmed-72425002020-05-26 Informed consent for surgery on neck of femur fractures: A multi-loop clinical audit Shah, Rohi Sambhwani, Sharan Al-Shahwani, Awf Plakogiannis, Christos Ann Med Surg (Lond) Original Research BACKGROUND: The Montgomery case in 2015 resulted in a pivotal change in practice, leading to a patient-centric approach for informed consent. Neck of femur (NOF) fractures are associated with a high rates perioperative morbidity and mortality. Using guidelines highlighted by the British Orthopaedic Association we performed a multi-loop audit within our department to assess the adequacy of informed consent for NOF fractures. METHODS: Two prior cycles had been performed utilising a similar framework. Prior interventions included ward posters, verbal dissemination of information at Junior Doctor's (JD) induction and amendments to the JD handbook. For the latest audit loop, a retrospective analysis of 100 patients was performed. Risk were classified as common, less common, rare and ‘other’ non-classifiable risks. The adequacy of informed consent was evaluated by assessing the quality and accuracy of documentation in the signed Consent Form-1s for compos mentis patients. RESULTS: Infection, bleeding risks, clots and anaesthetic risks were documented in all patients (100%). Areas of improvement included documentation of neurovascular injuries (98%), pain (75%) and altered wound healing (69%). There was no significant change in the documentation of failure of surgery (83%) and neurovascular injuries (98%). Poorly documented risk factors included mortality (21%), prosthetic dislocation (14%) and limb length discrepancy (6%). CONCLUSION: Following the latest cycle, the trust has now approved the use of 2 consent-specific stickers (for arthroplasty or fixation), amendable on a patient-to-patient basis. As part of the multi-loop process, the cycle will be repeated every year, in line with Junior Doctor rotations. Medical professionals have an ethical, moral and legal obligation to ensure they provide all information regarding surgical interventions to aid patients in making an informed decision. Elsevier 2020-04-08 /pmc/articles/PMC7242500/ /pubmed/32461800 http://dx.doi.org/10.1016/j.amsu.2020.03.008 Text en © 2020 The Author(s) http://creativecommons.org/licenses/by/4.0/ This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Original Research
Shah, Rohi
Sambhwani, Sharan
Al-Shahwani, Awf
Plakogiannis, Christos
Informed consent for surgery on neck of femur fractures: A multi-loop clinical audit
title Informed consent for surgery on neck of femur fractures: A multi-loop clinical audit
title_full Informed consent for surgery on neck of femur fractures: A multi-loop clinical audit
title_fullStr Informed consent for surgery on neck of femur fractures: A multi-loop clinical audit
title_full_unstemmed Informed consent for surgery on neck of femur fractures: A multi-loop clinical audit
title_short Informed consent for surgery on neck of femur fractures: A multi-loop clinical audit
title_sort informed consent for surgery on neck of femur fractures: a multi-loop clinical audit
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7242500/
https://www.ncbi.nlm.nih.gov/pubmed/32461800
http://dx.doi.org/10.1016/j.amsu.2020.03.008
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