Singh Kirit, Assaf Ali, Bayley Morgan, Gillespie Gordon
Department of Trauma and Orthopaedics, Royal Gwent Hospital, GNG T&O Secretaries Office, Level 5, Cardiff Road, Newport, NP20 2UB Wales.
Department of Trauma and Orthopaedics, Withybush Hospital, Pembrokeshire, Wales.
Patient Saf Surg. 2020 Jun 13;14:26. doi: 10.1186/s13037-020-00252-8. eCollection 2020.
Consenting patients for trauma procedures following hip fracture is a key stage in the treatment pathway from admission to the operating theatre. Errors in this process can result in delayed procedures which may negatively impact patient recovery. The aim of this project was to identify and reduce errors in our consenting process for patients with capacity.
Consent forms for all adult patients with capacity admitted for surgical repair of traumatic hip fracture were reviewed over a 4-week period. The baseline measurement ( = 24), identified errors in three key process measures: clarity of documentation, failure to record procedure-specific risks and not offering a copy of the consent form to the patient. Pre-printed stickers and targeted teaching were then introduced as quality improvement measures. Their impact was evaluated over subsequent 4-week review of the same patient demographic, with further refinement of these interventions being carried out and re-evaluated for a final cycle.
Cycle 1 ( = 26) following targeted teaching demonstrated a reduction in abbreviations from 38 to 20%, while doubling the documentation of discussion of procedure-specific risks from 31 to 72%. More patients were offered a copy of their consent form, rising from 12 to 48%. Cycle 2 ( = 24) saw the introduction of pre-printed "risk of procedure" stickers. Although clarity measures continued to improve, quality of pre-procedure risk documentation remained static while the number of forms being offered to patients fell to 8%.
Our project would suggest that while pre-printed stickers can be useful memory aids, specific teaching on consenting produces the greatest benefit. The usage of such tools should therefore be limited, as adjuncts only to specific training.
对于髋部骨折后需要进行创伤性手术的患者，在从入院到手术室的治疗过程中，获得其同意是关键阶段。这一过程中的错误可能导致手术延迟，从而对患者康复产生负面影响。本项目的目的是识别并减少针对有行为能力患者的同意过程中的错误。
对所有因创伤性髋部骨折入院接受手术修复且有行为能力的成年患者的同意书进行了为期4周的审查。基线测量（n = 24）发现了三个关键流程指标中的错误：文件记录的清晰度、未记录特定手术风险以及未向患者提供同意书副本。随后引入了预印贴纸和针对性教学作为质量改进措施。在对相同患者群体进行后续4周审查时评估了它们的影响，并对这些干预措施进行了进一步完善，最后一个周期再次进行评估。
在针对性教学后的第1周期（n = 26），缩写的使用从38%降至20%，同时特定手术风险讨论的记录增加了一倍，从31%增至72%。更多患者获得了同意书副本，比例从12%升至48%。第2周期（n = 24）引入了预印的“手术风险”贴纸。尽管清晰度指标持续改善，但术前风险文件记录的质量保持不变，而向患者提供同意书的比例降至8%。
我们的项目表明，虽然预印贴纸可以作为有用的记忆辅助工具，但关于同意过程的特定教学产生的益处最大。因此，此类工具的使用应受到限制，仅作为特定培训的辅助手段。
