What is the situation for senior medical staff?
Senior medical staff and senior trainees who have completed their final professional membership exams are assumed competent to take consent for all procedures in their specialty. To assist with NHSLA audit their names will be included in the departmental consent register.
What is the situation for a trainee on a specialist training programme?
Trainees on a specialist training programme who have not yet completed their final professional membership exam must have a record of authorisation to take consent in the departmental consent register. However they already have several years of training in their speciality. They have received training on consent and their conduct in relation to consent is under supervision of their Royal college. For these trainees, departments may at their discretion assume competence to take consent for some procedures but specify procedures for which they may NOT take consent. For example particularly complex procedures or those with a significant risk to life, limb or quality of life might be specified. Less experienced registrars may be treated as a junior trainee (see below)
What is the situation for Junior trainees not yet on a recognised training programme?
For these trainees such as core trainees there must be a record of authorisation to take consent for a procedure or group of procedures. There must also be a record that training has been given in taking consent for those procedures. Grouping similar procedures can make training more practicable and cover many of the procedures that might be undertaken in a particular specialty: In vascular surgery for example juniors might complete a module in taking consent for lower limb bypass procedures. In O+G a lecture may be given at induction on consent for emergency procedures. Provided it is recorded and of a sufficient standard, departments may deliver training in whatever way they think best.
What is the situation for non training grades?
Each department must decide whether it is more appropriate for a particular member of staff to be treated in the same way as senior medical staff, specialist trainees or junior trainees. They should then apply the guidelines as above.
What constitutes training?
Any record that there has been a discussion of issues surrounding consent can be interpreted as training. This would include;
- Formal training in a classroom setting or completion of a training module such as that provided to endoscopy nurses
- A talk at induction on issues surrounding consent for key procedures such as that provided for trainees in cardiology and obstetrics and gynaecology
- The completion of a PBA where there is a record that consent has formed part of the assessment.
- Informal bedside teaching on consent for a procedure is perfectly acceptable provided there is a record that this has taken place.
How much training is required will depend on the level of experience of the consent taker.
A registrar in the 4th year of training may simply require a discussion of 2 or 3 key points as part of a PBA. A year 1 CT may require completion of a formal training module. It may also be necessary to repeat training such as occurs now for endoscopy nurses. In determining whether training is adequate, senior staff should consider whether they could defend it's adequacy in a court of law.[/toggle]
When should consent be taken?
Where possible, consent should be taken prior to admission for a procedure. For elective patients, the process of consent starts in the outpatient department with the information provided to the patient prior to them being added to the list. Not all of this information is retained by the patient however and it may not be sufficiently comprehensive. Best practice is to provide the patient with written information in the outpatient clinic for them to take away, read and discuss with family and friends. As the trust must keep a written record of the information provided, it is preferred that this information is incorporated into a procedure specific consent form. As these become more widely available, they can be downloaded and printed in the outpatient department or pre-printed. Patients may sign them at the time or bring them back signed.
- Consent on the day of the procedure should be avoided except in emergency situations
- A “cooling off period” is recommended after consent is signed
- Details of any written information provided to the patient must be documented
Who is responsible for maintaining the consent register for each department?
It will normally be the responsibility of the governance lead to ensure that the register of authorisation to take consent is kept up to date. Junior staff will be expected to inform them of changes as their experience and training increase. This process is evolving. Thanks to all the many staff across the divisions who are already engaged in preparing procedure specific forms and training modules. Please contact the lead on consent if you have any suggestions or anticipate particular problems in your department (See “Getting advice on consent” for contact details).