The Online Journal of Clinical Audits, Vol 8, No 4 (2016)

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Informed Consent For Surgery On Neck Of Femur Fracture: A Prospective Re-Audit

Rohi Shah, Hemit Patel, Yosef Hamed, Shabih Siddiqui,

Abstract


Aims - The aim of this audit project was to assess the quality and accuracy of documentation of major risk factors whilst consenting patients undergoing surgical stabilisation of neck of femur (NOF) fractures. This was done utilising and adapting a framework developed by Probert et al. as well as interventions that occurred following the initial audit.

 

Methods - 50 consecutive prospective patients who had sustained a NOF fracture were identified from 1st April 2016. Those patients who scored an AMT ? 8 were deemed to have capacity to sign the Consent Form-1 and were therefore included in the study. The major risk factors for surgical interventions in NOF fractures were identified through direct documentation on the Consent Form-1. Each form that was included in the study was reviewed to assess how many of the mandatory risk factors of surgical intervention had been included

 

Results - 50 patients were identified as NOF fractures and every patient underwent a surgical intervention. Of this cohort, 33 patients (66%) were deemed to have capacity and had Consent Form-1 completed. As per the initial audit, the re-audit once again demonstrated variability in the number of risk factors recorded on the consent forms. Infection and bleeding were document in all patients included in the study (100%). Areas of notable improvement included documentation of neurovascular damage (93% to 97%), non-union/mal-union (33% to 58%), anaesthetic risks (53% to 76%), morbidity (40% to 61%). There was no gross change in the documentation of blood clots (93% to 91%) and failure of procedure (87% to 85%). However, a decline in the documentation of scar formation (60% to 42%), pain (73% to 42%) and stiffness (47% to 365) was noted.

 

Conclusions - While notable improvements were seen in many areas in comparison to the initial audit, the department is not yet achieving the recommended standard for documentation of all major risk factors. Once again, it was unclear from the consent form themselves whether the undocumented risk factors were conveyed to patients and whether it was a case of just not physically documenting them on the forms. Medical professionals have an ethical, moral and legal obligation to ensure they provide the information regarding the benefits and risks associated with surgical procedures to aid patients in making a decision.


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