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Content ArticleIn 2015, the ruling of the UK Supreme Court in Scotland in the case of Montgomery v Lanarkshire Health Board fundamentally changed the practice of consent. According to the Judges in this case, doctors are no longer the sole arbiter of determining what risks are material to their patients. They should not make assumptions about the information a patient might want or need but they must take reasonable steps to ensure that patients are aware of all risks that are material to them. The Royal College of Surgeons has developed guidance on consent that sets out the principles for working with patients through a process of supported decision-making, and a series of podcasts that illustrate those principles in practice.
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Content ArticleThis article by the Royal College of Obstetricians & Gynaecologists and The My Body Back Project provides tips for healthcare professionals to make cervical cancer screening attendees feel as comfortable as possible during their appointments. Cervical screening can be very daunting for some women, and for those who have experienced sexual violence it can be triggering and cause emotional distress. The article provides the following tips, with more detailed guidance: Communication – language and listening - build trust by listening and acknowledging rather than downplaying any concerns. A sense of calm – how can you can make the environment feel calm and safe? Share control – Consider how you can demonstrate shared control within the consultation and examination. Position – a good position can make all the difference to their comfort and your ability to visualise the cervix. It’s about time…. Offer a double appointment so there is time to check in, build trust and for the woman or person with a cervix to feel ready to be examined.
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News ArticleOccupational health professionals should avoid employment and management matters related to unvaccinated NHS staff, new guidance has warned. The Faculty of Occupational Medicine guidance comes as trusts are considering their options of how to approach patient-facing staff who remain unvaccinated, including their potential redeployment or dismissal. However, HSJ understands some occupational health practitioners are concerned they may become entangled in difficult ethical issues, such as the vaccination status of individual employees, or disciplinary processes. Today’s FOM guidance said: “There is no scope for occupational health practitioners to provide an opinion on medical exemptions, whether to confirm or refute them… “Redeployment, dismissal and other employment consequences of vaccine refusal by a worker, within the scope of the proposed regulations, are entirely employment and management matters, and not an area in which occupational health should be involved.” FOM president Steve Nimmo said: “When the programme is implemented, occupational health professionals should be mindful of ethical and consent issues, and be careful not to be associated with any disciplinary process.” Read full story (paywalled) Source: HSJ, 7 January 2022
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Content Article
In this personal account, hub member Sophie talks about the trauma she experienced after a painful contraceptive device (IUD) fitting, and the impact this has had on her subsequent experience of medical procedures. She argues that damaging narratives around female pain cause harm to patients in multiple ways and have consequences that reach far beyond the initial experience of pain.- Posted
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Content ArticleThis article in The BMJ discusses the consequences for practising doctors of the 2015 Montgomery v Lanarkshire Case. The case was brought by Nadine Montgomery, a woman with diabetes and of small stature, after she delivered her son vaginally and experienced complications during the birth which resulted in her son having cerebal palsy. Her obstetrician had not disclosed the increased risk of this complication in vaginal delivery, despite Montgomery asking if the baby’s size was a potential problem. The Supreme Court ruling in her favour established that a patient should be told whatever they want to know, not what the doctor thinks they should be told.
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Content ArticleIn this episode of BBC Panorama, Reporter Deborah Cohen investigates how medical devices can cause harm to patients, and the lack of support and redress available when things go wrong.
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Content ArticleRhian Rose underwent feticide on 22 November 2019 and was admitted to a maternity ward on 24 November 2019 for medical termination of pregnancy. By the evening of her admission, Rhian had clear symptoms of infection, however the sepsis pathway and antibiotics were not commenced until the following morning. In the late afternoon on 25 November 2019, Rhian became acutely unwell resulting in unconsciousness, emergency caesarean section, subsequent cardiac arrest and eventually her death. In this report the Coroner raises concerns about a lack of informed consent and discussion of maternal wishes and the mode of delivery highlighted by this case. He highlights a lack of guidance relating to the infection risk when a mother is attending for delivery following feticide.
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This is the fourth of a short series of blogs in which we take a look back at our work in five areas of patient safety during 2021. In this blog we consider the need for greater patient engagement to support improvements to patient safety. Throughout our work, Patient Safety Learning seeks to harness the knowledge, insights, enthusiasm and commitment of health and social care organisations, professionals and patients for system-wide change and the reduction of avoidable harm. We believe patient safety is not just another priority; it is a core purpose of health and social care. Patient safety should not be negotiable. -
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Birthrights video: Speak Up, Speak Out (16 November 2021)
Patient-Safety-Learning posted an article in Maternity
This video by the charity Birthrights encourages women and birthing people to speak out when they experience poor quality care. It highlights the right to safe and appropriate maternity care that respects individuals' dignity, privacy and confidentiality and is given equally and without discrimination. -
Content ArticleThis patient decision aid from the National Institute for Health and Care Excellence (NICE) aims to help adults with type 2 diabetes understand the risks and benefits of taking a second medication, so that they can make an informed decision about their care.
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Content ArticleThis patient decision aid from the National Institute for Health and Care Excellence (NICE) aims to help family members and carers of severe stroke patients under 60 understand the risks and benefits of decompressive hemicraniectomy, so that they can make an informed decision about treatment.
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Content ArticleThis patient decision aid from the National Institute for Health and Care Excellence (NICE) aims to help patients with high blood pressure understand the risks and benefits of different treatment options so that they can make an informed decision about their care.
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Content ArticlePoppy Harris was born at Milton Keynes University hospital on 23 November 2020. Following a protracted labour, she was delivered using Kielland's forceps. She was transferred to John Radcliffe Hospital in Oxford where it was discovered that she had suffered a spinal cord injury and despite all efforts and care she died on 24 March 2021.
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Content ArticleShared decision making (SDM) is when patients and clinicians work together to make evidence-based decisions based on patient values and preferences. This may be to select a test or intervention, such as going ahead with surgery. SDM ensures individuals are supported to make decisions which are right for them. The Centre for Perioperative Care has a number of resources on their website on shared decision making.
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Content ArticleThis innovative educational initiative was developed as a direct and constructive response to the communication inadequacies exposed by the Montgomery case, and subsequent legislation. While it is not difficult to give ‘more information’ it is harder for surgeons and patients to achieve a decision partnership. The ICONS workshop content has been informed by internationally recognised experts in Shared Decision Making, by consensus among senior practising surgeons, by patients and by professional experts in risk management and risk communication. Delegates on the ICONS workshops will acquire skills and knowledge to implement best practice in sharing the complex decisions surrounding informed consent. By participating in a workshop, they will also contribute to the development of resources for future training in the important area of informed consent.
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Content ArticleThe Medicines & Healthcare products Regulatory Agency (MHRA)'s first 'Patient Involvement Strategy' sets out how they will engage and involve the public and patients at each stage of the regulatory journey. The MHRA involved patients throughout the process of developing this strategy and carried out a final public consultation before it was published. The strategy identifies five priority areas for the MHRA: Patient and public involvement Responsiveness Internal culture Measuring outcomes Partnerships.
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Pregnant people receive many public health messages that are intended to guide their decision making; intended to improve outcomes for babies and mothers. However, there is growing concern that messages do not always fully reflect or explain the evidence base underpinning them, and that negotiating the risk landscape can sometimes feel confusing, overwhelming, and disempowering. This may negatively affect women’s experiences of pregnancy and motherhood, and be exacerbated by a wider culture of parenting that tends to blame mothers for all less-than-ideal outcomes in their children. The WRISK Project draws on women’s experiences to understand and improve the development and communication of risk messages in pregnancy. -
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More and more women are coming forward to share their stories of a painful IUD procedure. In this blog for the BMJ Opinion, Stephanie O’Donohue (Content and Engagement Manager for Patient Safety Learning) argues that healthcare services need to get better at recording these experiences. The ripples of trauma caused by severe pain during IUD procedures If you have had an IUD fitted and would like to share your experience, please visit our community forum and share your views. Related reading The pain of my IUD fitting was horrific…and I’m not alone The normalisation of women’s pain Through the hysteroscope: Reflections of a gynaecologist Improving hysteroscopy safety (Patient Safety Learning, November 2020) -
Content ArticleThis article in the Nursing Times explains how the law has evolved and how it applies to nursing practice, describing the legal duty of nurses to obtain informed consent from their patients before carrying out any treatment or intervention, and why informed consent is fundamental to the provision of person-centred care.
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Content ArticleThis report from the Patients Association describes shared decision making and its benefits, before going on to assess how it has been formally embedded in NHS programmes and practice. It identifies the barriers preventing shared decision making becoming a reality for patients as a matter of course, and possible solutions.
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Content Article
What I never consented to (24 June 2021)
Mark Hughes posted an article in Consent issues
In this blog in the BMJ, Andrés J Lessing considers how consent forms and conversations about care and treatment often do not account for the possibility of incidental findings. The author suggests that incidental findings can be very stressful for patients and that as part of the pre-treatment consent process healthcare professionals could provide a reminder about the likelihood of incidental findings and what might be done to address them. -
EventuntilThis webinar is sponsored by BD. Learning Outcomes Understanding management, around issues of consent. Recognise the importance and relevance of the Montgomery legislation in the model of shared decision making. Gain insight around empowerment of the patient in informed consent. Be able to explore issues around extended roles in shared decision making. Speaker: Prof Janet Wilson, Emerita Prof of Otolaryngology, Newcastle University & Council Member RCSEd.
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Lucy Cohen recently had a contraceptive device (IUD) fitted, during which she suffered extremely high levels of pain. Following her experience, she decided to launch a survey to understand how others had found the procedure. In this interview, Lucy shares her findings and calls for better pain management and improved consent processes, in order to reduce avoidable harm. -
EventuntilThis session presented by AfPP, aims to help attendees understand more about patient informed consent and shared decision-making. Learning outcomes: Understanding management, around issues of consent. Recognise the importance and relevance of the Montgomery legislation in the model of shared decision making. Gain insight around empowerment of the patient in informed consent. Be able to explore issues around extended roles in shared decision making. Register
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Content ArticleThis article discusses evidence that doctors-in-training and medical students are still performing pelvic exams on anesthetized women without their consent.
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