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Content ArticleThe General Medical Council has published an updated guide on Decision making and consent, which comes into effect on 9 November 2020. The guidance aims to support doctors to practise shared decision making and help their patients to make healthcare decisions that are right for them. New features include: a focus on taking a proportionate approach, acknowledging not every paragraph of the guidance will be relevant to every decision seven key principles which summarise the guidance a new section to help doctors find out what matters to patients so they can share relevant information to help them decide between viable options suggestions for how other members of the healthcare team can support decision making.
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News ArticleFor more than two decades, Derek McMinn harvested the bones of his patients, according to a leaked report – but it was not until last year that anyone challenged the renowned surgeon. The full scale of his alleged collection was apparently kept from the care regulator until just days ago, and thousands of those who went under his knife for hip and knee treatment still have no idea that their joints may have been collected in a pot in the operating theatre, and stored in the 67-year-old’s office or home. Clinicians and managers at the BMI Edgbaston Hospital, where McMinn carried out the majority of his operations, actively took part in the collection of bones and – even after alarms were raised – the hospital did not immediately act to stop the tissue being taken away, according to a leaked internal report seen by The Independent. An investigation found operating theatre staff at the private hospital left dozens of pots containing joints removed from patients femurs during hip surgery in a storage area, in some cases for months. According to the report, there had been warnings about their responsibilities under the Human Tissue Act when an earlier audit between 2010 and 2015 identified the storage of femoral heads, the joints removed in the procedure. The internal report said there was no evidence McMinn had carried out any research or had been approved for any research work – required by the Human Tissue Authority to legally store samples. It said one member of staff told investigators the samples were being collected for research on McMinn’s retirement. Although the Care Quality Commission knew about claims that a small number of bones being kept by McMinn, it is understood that the regulator received a copy of the BMI Healthcare investigation report only last Friday, after The Independent had made initial inquiries about the case. That report suggests a minimum of 5,224 samples had been taken by McMinn. The regulator confirmed to The Independent it had not been aware of the extent of McMinn’s supposed actions. An insider at BMI Healthcare accused the company of “covering up”, adding: “Quite senior staff at the hospital went along with it and just handed the pots over to his staff when they came to collect them.” Read full story Source: The Independent, 30 September 2020
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Content Article
The process of informed consent: A presentation
Shamim Odera RN posted an article in Consent and privacy
This presentation explains the process of informed consent and has been adapted from the National Institute for Health Research (NIHR) Introduction to Good Clinical Practice (GCP) Training.- Posted
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Content ArticleThis video from NHS Resolution looks at the criteria that need to be met in order for patient consent to be legally valid. Advice is provided on how to ensure practitioners obtain legally valid consent.
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Content ArticleThis Heathcare Huddle video focuses on key themes that came out of the First Do No Harm report. You can watch it in two parts or as one full video. PART ONE (with Darren Thorne, Managing Director of Facere Melius) - Theme 1: ‘No-one is listening’ – The patient voice dismissed - Theme 2: ‘I’ll never forgive myself’ – Parents living with guilt - Theme 3: ‘I was never told’ – the failure of informed consent PART 2 - Theme 4: Redress – ‘We want justice’ - Theme 5: ‘We do not know who to complain to’ – Complaints - Theme 6: Duty of Candour – ‘preventing future errors’ - Theme 7: Conflicts of interest – ‘we deserve to know’.
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Content ArticleInformed consent is a person’s decision, given voluntarily, to agree to a healthcare treatment, procedure or other intervention that is made: Following the provision of accurate and relevant information about the healthcare intervention and alternative options available; With adequate knowledge and understanding of the benefits and material risks of the proposed intervention relevant to the person who would be having the treatment, procedure or other intervention. Ensuring informed consent is properly obtained is a legal, ethical and professional requirement on the part of all treating health professionals and supports person-centred care. Good clinical practice involves ensuring that informed consent is validly obtained and appropriately timed. This fact sheet from the Australian Commission on Safety and Quality in Healthcare includes information for clinicians about informed consent in healthcare.
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Content ArticleIn this editorial for the British Medical Journal, Helen Haskell summarises the findings and recommendations of the Cumberlege Review, First Do No Harm. Helen argues that while the report has the potential to be a powerful tool for change in and beyond the UK, patients and families now need to see evidence of action.
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Content ArticleThis paper, published in the Journal of patient safety, provides evidence from the patient perspective that consent forms are too complex and fail to achieve comprehension. Future studies should be conducted using patients’ suggestions for form redesign and inclusion of supplemental educational tools in order to optimise communication and safety to achieve more informed healthcare decision making.
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Content ArticleThis article, published in the US-based Journal of healthcare information management, looks at the relationship between consent and patient safety. The author, James E. Gottesman, highlights the benefits of clear communication between clinician and patient.
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Nadine’s story: Informed consent (the Montgomery case)
Claire Cox posted an article in Consent and privacy
In this short film, Nadine Montgomery presents her story that led to the landmark ruling on consent (Montgomery v Lanarkshire Health Board, 2015) -
Content Article
Informed consent: A short film
PatientSafetyLearning Team posted an article in Consent and privacy
This short creative film, produced by A.O Consultancy, explains what it means to give informed consent to medical treatment.- Posted
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Content ArticleSince the rise of COVID-19 in the UK, many consultations between surgeons and patients take place remotely, via phone or video. These consultations include pre-operative assessments, discussions between surgeons and patients about the benefits and risks of their surgery, and gaining the patient’s consent to proceed with treatment. This transition to remote consultations has been central in the healthcare system’s effort to prevent transmission of COVID-19, and has required a series of adjustments by patients, hospitals and members of the surgical team. However, when it comes to the consent process, the same principles and requirements should apply as set out by the GMC and The Royal College of Surgeons of England, regardless of whether the conversation takes place face-to-face or via phone or video. In addition, during the COVID-19 period, the consent discussion should include further considerations to ensure that patients have the necessary information to make an informed decision about their treatment. This guide sets out the main principles of the consent process and provides advice on what additional information should be included in conversations with patients while COVID-19 is still prevalent in society.
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How should surgeons obtain consent during the COVID-19 pandemic?
Patient Safety Learning posted an article in Blogs
Now that hospitals are resuming elective surgery, what should surgeons tell patients about the perioperative risks of COVID-19? Many surgeons are now resuming elective work, yet some make no mention of the additional covid-related risks. Although the British Association of Spine Surgeons and some private hospitals have produced information sheets for patients undergoing surgery during the pandemic, to our knowledge no formal guidance has been issued by the General Medical Council or the Royal College of Surgeons on obtaining consent in such circumstances. The surgical community remains unclear as to what to tell patients about to undergo elective surgery. In this BMJ Opinion article, Daniel Sokol and Rupen Dattani argue that patients who undergo elective surgery should be told that, despite measures to limit the risk of infection, there remains a risk of contracting covid-19 in hospital, whether before, during or after the operation. -
Content ArticleThese controversial implants are used by medical professionals to treat stress incontinence and pelvic organ prolapse, both of which can occur after childbirth. But there’s a darker side to the mesh story, with many women left in excruciating pain, suffering long-term health problems as a result of being fitted with them. This article in Woman & Home explores the issues around vaginal mesh implants and speaks to women and campaigners.
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AHRQ's easy-to-understand telehealth consent form
Patient Safety Learning posted an article in Telehealth
AHRQ's easy-to-understand telehealth consent form is part of AHRQ's Health Literacy Improvement Tools to help healthcare organisations, leaders and professionals improve health literacy. AHRQ's telehealth consent resources include a sample telehealth consent form that is easy to understand and how-to guidance for clinicians on obtaining informed consent for telehealth. The consent form includes provisions for healthcare providers that have curtailed in-person visits due to COVID-19. Clinicians can use the easy-to-understand language from the form when they are having the consent discussion and can use the form as a checklist to make sure they have covered all the information required by informed consent rules.- Posted
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Painful hysteroscopy
Claire Cox posted a topic in Patient stories
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*Trigger warning. This post includes personal gynaecological experiences of a traumatic nature. What is your experience of having a hysteroscopy? We would like to hear - good or bad so that we can help campaign for safer, harm free care. You can read Patient Safety Learning's blog about improving hysteroscopy safety here. You'll need to be a hub member to comment below, it's quick and easy to do. You can sign up here.- Posted
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Consent to treatment: Overview
Claire Cox posted an article in Consent issues
Consent to treatment means a person must give permission before they receive any type of medical treatment, test or examination. This must be done on the basis of an explanation by a clinician. Consent from a patient is needed regardless of the procedure, whether it's a physical examination, organ donation or something else. The principle of consent is an important part of medical ethics and international human rights law.- Posted
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Outpatient hysteroscopy: RCOG patient leaflet
Claire Cox posted an article in Women's health
This leaflet, produced by the Royal College of Obstetricians and Gynaecologists and the British Society for Gynaecological Endoscopy, is for individuals who have been offered hysteroscopy as an outpatient. It may also be helpful if you are a partner, relative or friend of someone who has been offered this procedure.- Posted
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RCOG: The impact of the Montgomery ruling (2016)
PatientSafetyLearning Team posted an article in Consent issues
This article, published by the Royal College of Obstetrics and Gynaecology (RCOG), talks about the 2015 Supreme Court decision on Montgomery vs NHS Lanarkshire. The Ruling has significant implications for doctor–patient communications, information sharing and informed consent. Since the ruling, the College leadership has been meeting with medico-legal experts to fully understand the impact on the profession and to determine the RCOG’s role in supporting our members to work within a shared decision-making model.- Posted
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Content ArticleThis leaflet, produced by Kingston Hospital, is designed to prepare women for hysteroscopy procedures that are performed in the gynaecology outpatients department. Join the conversation on the hub about hysteroscopies.
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News Article
NHS use of puberty blockers legal challenge begins
Patient Safety Learning posted a news article in News
Legal action is being launched against the NHS over the prescribing of drugs to delay puberty. Papers have been lodged at the High Court by a mother and a nurse against the Tavistock and Portman NHS Trust, which runs the UK's only gender-identity development service (Gids). Lawyers will argue it is illegal to prescribe the drugs, as children cannot give informed consent to the treatment. The Tavistock said it had a "cautious and considered" approach to treatment. The nurse, Sue Evans, left the Gids more than a decade ago after becoming increasingly concerned teenagers who wanted to transition to a different gender were being given the puberty blockers without adequate assessments and psychological work. Ms Evans said: "I used to feel concerned it was being given to 16-year-olds. But now, the age limit has been lowered and children as young as perhaps 9 or 10 are being asked to give informed consent to a completely experimental treatment for which the long-term consequences are not known." Read full story Source: BBC News, 8 January 2020- Posted
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National Safety Standards for Invasive Procedures
Annie Hunningher posted a topic in Surgery
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How are people getting on with the NatSSIPs? PDF version to share NatSSIPs headline booklet.pdf- Posted
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Content ArticleNHS Resolution received 1,223 claims for incidents occurring between 2012 and 2017 that have cost the NHS £233 million so far. Of these cases, 728 claims are under review due to the complexities around consent. Consent can be a common contributing factor in many claims. This leaflet looks at examples of failure to provide adequate consent, a breakdown of these kinds of claims by clinical speciality, the importance of the Montgomery ruling and what supported decision making looks like.
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Community PostI would like to open a discussion about how 'lack of written consent' and how this is managed in investigations.