New draft guideline AAGBI: Consent for anaesthesia 2016 Comments invited from members

A new draft guideline on consent for anaesthesia is in its final draft stage and comments are invited from members. Please read the draft and submit comments to workingparties@aagbi.org. All comments submitted will be considered before a final version is brought before the AAGBI Board for approval. Comment submission is now closed.

AttachmentSize
AAGBI Consent glossy 2016 consultation draft.pdf212.27 KB
AAGBI Consent glossy 2016 consultation draft App 1.pdf163.95 KB
Consent glossy 2016 consultation draft App 2 FAQs.pdf143.88 KB

Comments

consent

Thank you for a thorough yet concise guideline.



  1. In the section on timing should we state that the majority of patients are admitted on the day of surgery and this means that current practice is for the anaesthetist to discuss anaesthesia on the day of surgery. This may mean that anaesthesia is administered soon after the discussion.  Wherever possible these patients should have written information prior to the day of surgery.

  2. In the section on training “In some cases, e.g. a novice in fibreoptic orotracheal intubation wishing to learn the technique during general anaesthesia, patients’ specific consent should be sought since there may be additional risks from inexperienced use and there are limited benefits to the patient.” I feel this should be changed  to “……a novice in orotracheal intubation wishing to learn the technique of laryngoscopy or fibreoptic orotracheal intubation during general anaesthesia, patients’ specific consent should be sought for the role of the learner since there may be additional risks from inexperienced use”.  Or a "…novice wishing to learn a technique patients’ specific consent should be sought for the role of the learner since there may be additional risks from inexperienced use”

I note that “Patients must be

I note that “Patients must be informed of alternative treatments, the risks associated with them and the option of not receiving treatment; not doing so may invalidate consent and result in a negligence claim.” I do not see how all of this can be accommodated in the steadily reducing time allocated for pre-op visits. This would be akin to my previous “high risk pregnancy” anaesthetic clinic where it took some 30 – 40 minutes per patient to go through the options and associated risks – and then, equally important, document all of this in detail. While a tick box may act as aide memoire, it does not indicate what complications were or were not discussed.

There is no information about the 14 – 15 year old (possibly younger), who clearly has capacity and understanding, but takes a diametrically opposite view to the parent, either to have or to not have the proposed treatment/anaesthetic.

If a patient lacks capacity and has no-one specifically designated in law to make decisions on their behalf, Does Montgomery apply, and if so, with whom would such detailed discussions take place?

Consent

Generally a grat resource and great read although could be shorter.

A few specific points:

Assumptions relating to capacity based on age, appearance or behaviour cannot be made

Comment they 'can' be made but 'should not'! 

What does LPA stand for? Could this paragraph be simplified - it is confusing?

In the section on timing greater aknowledgement could be made of the fact that vitually all patients are now admitted on the day of surgery and the challenge this poses