Audit of consent in hip fracture

12^th International Conference on ORTHOPEDICS, OSTEOPOROSIS & TRAUMA

November 13-14, 2019 | London, UK

Victoria Beynon

Frimley Health Foundation Trust, UK

ScientificTracks Abstracts: J Orthop Trauma Surg Rel Res

Abstract :

Background/Aim: Following Montgomery v Lanarkshire (2015) issues surrounding consent are increasingly subject to litigation. The GMC is currently updating its guidance, emphasising a patient-centred approach, particularly in relation to perioperative risk.

Consent in hip fracture is frequently undertaken by SHO grade doctors who may be unfamiliar with the procedure, potentially compromising quality of consent.

This audit-cycle’s aim was to assess standard of consent in hip fracture and implement interventions to improve practice.

Study Design: The audit examined Consent Form 1 for NOF patients admitted over two months. Standards were taken from the BOA guideline ‘OrthoConsent’. Data included; accurate completion of consent form, grade of health-professional and legibility.

The number of documented peri-operative risks were totalled, categorised into three ranges (0-4), (5-9), (10-16) and allotted a score (1, 2 or 3 respectively).

Following initial audit, intervention included education from medical and medico-legal professionals and provision of electronic guidelines. Re-audit followed intervention.

Results: Baseline assessment comprised 40 consent forms, 22 (55%) completed by SHOs & 18 (45%) by SpRs, with 100% legibility. Patient demographics, indication, procedure & anaesthesia were documented in 95% of cases.

Consultants confirmed consent in 7 (17.5%) cases. 2 (5%) provided patient copies. For risk documentation, 3 forms scored 1 (7.5%), 34 scored 2 (85%) & 3 scored 3 (7.5%).

Re-audit was conducted for 45 consent forms; 41 (91.1%) by SHOs & 4 (8.9%) by SpRs. Results were similar for all parameters bar risk documentation. No forms scored 1, 18 scored 2 (40%), 27 scored 3 (60%). The standard of SHO consent was similar to SpR.

Conclusions: Results showed overall improvement in documented peri-operative risk, with those scoring 3 increasing to 60%. The education intervention also had the unintended effect of improving SHO’s confidence in consenting such that, at re-audit, only 9% of patients were consented by a registrar.

Biography :

Victoria Beynon is a post-foundation junior doctor and an aspiring surgeon. Her research interests include quality improvement for junior doctors, patient safety and medical education. She is currently a student at St. George’s University of London undertaking a Post Graduate Certificate in Medical Education and has been made an Honorary Clinical Lecturer at the University. She works closely with multiple research groups and is currently involved in a number of ongoing projects collaborating with Orthopedic, Urology and General Surgical teams. She hopes to take up a Core Surgical Training post in the next year to further her career.

E-mail: Victoria.Beynon1@nhs.net