Download - Informed consent for hip fractures
Informed consent for geriatric hip fractures
Dr Uday Kumar MS(Orth) DNB(Orth)Sagar HospitalsSindhi HospitalChinmaya Hospital Bangalore
6th Sept 2015 ASRAM MC ELURU
75 year old lady---fracture neck femur
Treatment?
80 year old male ----trochanteric fracture
Treatment?
What is “Consent?”
Defined as permission, approval, or assent
Consent given by the patient based on knowledge of the procedure to be performed, including its risks and benefits, as well as alternatives to the proposed treatment.
What is “INFORMED Consent”?
-- is no longer an option.
It is now a must under the current
guidelines & regulations
INFORMED Consent
Informed consent is it
a Document or a Process ??
Consent is a continuous process, not a one-time event
pre op Intra opPost op
Elderly patients
Co-morbid conditions
HypertensionDiabetesIHDCOPDOsteoporosis
Elderly patients are particularly vulnerable in theinformed consent process.
• Medical conditions: Impairs cognition e.g.hearing loss, vision loss
• Social Factors: physical dependency, financial impoverishment, restricted health care resources and family pressures
The Consent process:
Information provided
Information understood
Decision made
Comprehension
monitored and
maintained
VoluntarinessDisclosure
Competence Understanding
REQUIREMENTS
The Process of Consent:• Choose the right environment and location
• Involve multiple health care personnel – surgeon, physician, anesthetist, cardiologist etc
• Include all family members in the process
Consent Process PlanDecide where consent discussion will be held
• Conduct it in a quiet area
• Patient and attenders should have adequate uninterrupted time
Provide space for family members or friends to be present during the consent discussion
Consent Process PlanProvide adequate time to explain the surgery procedure to the attenders• Draw a visual description of the procedure
• Use patient education tools / brochures to assist in discussion
• Explain the responsibilities of the attenders— get them over to your side
Consent Process PlanProvide adequate time for patient/attenders to read and consider
- No undue influence or coercion- Allow them to discuss with families or friends
Provide time for questions to be answered aboutmorbidity and mortality and alternative treatments
Summary for Consent for surgery
Benefits
Contact
Purpose Risks
Alternative Confidentiality Costs
Voluntary
DatePatient orLegally Acceptable Representative
Surgeon Date
DateWitness
Who can sign the Consent Form?
Impartial Witness
A good consent form: Complete information Accurate information In compliance with regulations
and guidelines Short simple sentences Simple understandable
language Culturally sensitive language
Common Findings: Too long consent form Too complicated language Not all the complications are
mentioned Alternative treatments not given
Common Findings: • Surgical procedures are not accurately
described
• Benefits of the operation are over-stated
• Risks are not completely mentioned
Challenges regarding informed consent
Two main challenges in our country:• Illiteracy
•Culture,traditions and religion
Honesty
buildsTrust
Take home message
Take a proper informed consent
Get the attenders to your side
Explain all the pros and cons of the surgery planned
Inform the progress of the patient pre, intra and post op
Do not perform heroic surgery on the elderly
Respect your elders if
you want to get respected.
Thanks