Forensic Nursing Chronicles

I find the articles regarding informed consent exceedingly interesting. It was a subject that was recently brought to my attention regarding Radiography Techs and consent for IV contrast. For years, RT’s were able to witness consent, then all of a sudden they could not. Being the only RN in a busy Imaging Department, this became a huge burden. I did some research recently and found articles from ARRT that describes the RT Scope of Practice. Their scope of practice specifically states that they are to “verify” that consent was obtained. Now comes another wrench. There is no definition of “verify” and in our department, it had become a bone of contention among the Radiologists that the ordering provider was responsible for “Informed Consent”, to include risks, benefits, options, etc. Now comes the fun part: Some practitioners don’t even order the proper tests. Try convincing a steadfast NP that by ordering a CT Thorax WITH CONTRAST, they were actually prescribing the contrast. She did not appear to get what I was trying to explain to her. (She must have finally, because she began to order tests without contrast, which is a questionable practice because it may not always be the best exam for a patient and they have a delay in care or another CT with contrast) I even went so far as to go to the ANA website and download the RN Scope of Practice, which explains consent is again “verified”, not witnessed like we do. Both the NYS DOH and DOE do not specifically state whether an RN or an RT respectively can or cannot witness consent forms. It has come down to many crucial conversations between patient and staff and the knowledge of the patient regarding testing. If this wasn’t my job, I would find it rather humorous and ironic, all these issues that arise that are truly not addressed in the RT or RN Scope of Practice.

Original Post:
February 2, 2009
Informed Consent: Is It Really Understood?, comment
I work in a Liver Failure Clinic and have end stage liver failure patients. I perform paracentesis procedures to remove fluid from some of these patients peritoneum. The patients are in pain need fluid taken of their peritoneum NOW so they can breathe.
The patient has to be able to make decisions to sign the consent.
We inform the patient they may need blood if a vessel was punctured. We tell them they may get an infection and even die.
We have the patient sign on a pad that transmits the signature to a computer. A witness and I sign it also.
 All of this is before the procedure is done.
Never has a patient not wanted the procedure even when death, bleeding, pain and infection were mentioned in the informed consent.

I agree that it is important to have an informed consent. It takes time and sometimes the patient’s signature is almost unrecognizable.
There is pressure on the patient and staff to get this signature. I agree that sometimes the patient does not really know what is going to happen because they are in need of the procedure now. We explain the entire procedure to them before the procedure but just how much is really understood is questionable.

Original Post:
July 10, 2008
Informed Consent: Is It Really Understood?
It is good to see the topic of informed consent included in the text book Health Promotion Throughout the Lifespan. As a nurse, who practiced for twenty plus years in the acute care field, this topic is of vital interest to me. It was not often enough that I felt patients fully understood what they were agreeing to. Now, with mounting concerns about patient safety and lawsuits arising out of botched communications, the area of informed consent is drawing national attention. Informed consent is one aspect of patient autonomy. Informed consent occurs when with “substantial understanding” and without substantial control by others an individual authorizes a professional to do something. As a witness to the typical “informed consent” process, in the acute care setting, it is no wonder that breeches in patient autonomy are realized and being awarded financial remuneration following legal action. In my opinion, critical flaws in the current system include; the patient condition at the time information is being provided, lack of complete information including treatment alternatives, lack of patient education prior to procedures including the recovery phase, lack of time to process information, cumbersome written consent documents, language and other communication barriers. The Centers for Medicare and Medicaid Services have now called upon hospitals to design patient-friendly informed-consent processes. Theses processes are now required to include treatment alternatives and the consequences of declining recommended therapies. The Joint Commission, which accredits hospitals, is advocating the use of easy-to-read forms and the use of “teach-back” methods, which involve asking patients to repeat back what they have been told about the proposed treatment, risks and benefits. The Department of Veterans Affairs (VA) hospital system is conducting several new studies in the area of informed consent utilizing the “teach-back” method to determine patient understanding. It is the beginning of what I believe to be a long overdue focus in healthcare delivery. Hopefully, the information gained will be utilized in a standardized approach to increase patients understanding of proposed treatments with the outcome of preserving patient autonomy.

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