Thiruchandran Gajendiran, McKean Andrew R, Rudran Branavan, Imam Mohamed A, Yeong Keefai, Hassan Abdel
Registrar, Department of Trauma and Orthopaedics, Frimley Park Hospital, Camberley, Surrey.
Core Surgical Trainee, Department of Trauma and Orthopaedics, Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, Surrey.
Br J Hosp Med (Lond). 2018 May 2;79(5):284-287. doi: 10.12968/hmed.2018.79.5.284.
Background Neck of femur fractures and their subsequent operative fixation are associated with high rates of perioperative morbidity and mortality. Consenting in this setting is suboptimal with the Montgomery court ruling changing the perspective of consent. This quality improvement project assessed the adequacy of consenting against British Orthopaedic Association-endorsed guidance and implemented a series of changes to improve the documentation of risks associated with surgery for fractured neck of femur. Methods Seventy consecutive patients who underwent any operative fixation of a neck of femur fracture were included over a 6-month period at a single centre. Patients unable to consent or without electronic notes were excluded. Consent forms were analysed and the documented potential risks or complications associated with surgery were compared to British Orthopaedic Association-endorsed guidance. A series of changes (using the plan, do study, act (PDSA) approach) was implemented to improve the adequacy of consent. Results Documentation of four out of 12 potential risks or complications was recorded in <50% of cases for patients with intracapsular fractures (n=35), and documentation of seven out of 12 potential risks or complications was recorded in <50% of cases for patients with extracapsular fractures (n=35). Re-audit following raising awareness and attaching consent guidance showed 100% documentation of potential risks or complications in patients with intracapsular and extracapsular fractures (n=70). A neck of femur fracture-specific consent form has been implemented which will hopefully lead to sustained improvement. Conclusions Consenting patients with fractured neck of femur for surgery in the authors' unit was suboptimal when compared to British Orthopaedic Association-endorsed consent guidance. This project has shown that ensuring such guidance is readily available has improved the adequacy of consent. The authors hope that introduction of a neck of femur fracture-specific consent form within their unit will lead to sustained adequate documentation of risks associated with surgery.
股骨颈骨折及其后续手术固定与围手术期高发病率和死亡率相关。在这种情况下，由于蒙哥马利法院的裁决改变了同意的视角，同意过程并不理想。本质量改进项目根据英国骨科协会认可的指南评估了同意的充分性，并实施了一系列变革以改善股骨颈骨折手术相关风险的记录。方法：在一个单一中心的6个月期间，纳入了70例连续接受任何股骨颈骨折手术固定的患者。排除无法同意或没有电子病历的患者。分析同意书，并将记录的与手术相关的潜在风险或并发症与英国骨科协会认可的指南进行比较。实施了一系列变革（采用计划、执行、研究、行动（PDSA）方法）以提高同意的充分性。结果：对于囊内骨折患者（n = 35），12种潜在风险或并发症中的4种在不到50%的病例中被记录；对于囊外骨折患者（n = 35），12种潜在风险或并发症中的7种在不到50%的病例中被记录。提高认识并附上同意指南后的重新审核显示，囊内和囊外骨折患者（n = 70）中潜在风险或并发症的记录率为100%。已经实施了一份股骨颈骨折专用同意书模板，有望带来持续改进。结论：与英国骨科协会认可的同意指南相比，作者所在单位对股骨颈骨折患者进行手术同意的情况并不理想。该项目表明，确保此类指南随时可用可提高同意的充分性。作者希望在其单位引入股骨颈骨折专用同意书模板将导致与手术相关风险的持续充分记录。
