Informed Consent For Surgery On Neck Of Femur Fracture: A Multi-Loop Clinical Audit

Informed Consent For Surgery On Neck Of Femur Fracture: A Multi-Loop Clinical Audit
Rohi Shah, Sharan Sambhwani, Awf Al-Shawani, Christos Plakogiannis
Annals of Medicine and Surgery, 8 April 2020
Open Access
The Montgomery case in 2015 resulted in a pivotal change in practice, leading to a patient-centric approach for informed consent. Neck of femur fractures are associated with a high rates perioperative morbidity and mortality. Using guidelines highlighted by the British Orthopaedic Association we performed a multi-loop audit within our department to assess the adequacy of informed consent for NOF fractures.
Two prior cycles had been performed utilising a similar framework. Prior interventions included ward posters, verbal dissemination of information at Doctor’s induction and amendments to the JD handbook. For the latest audit loop, a retrospective analysis of 100 patients was performed. Risk factors were classified as common, less common, rare and ‘other’. The adequacy of informed consent was evaluated by assessing the quality and accuracy of documentation in the signed Consent Form-1s.
Infection, bleeding risks, clots and anaesthetic risks were documented in all patients(100%). Areas of improvement included documentation of neurovascular injuries(98%), pain(75%) and altered wound healing(69%). There was no significant change in the documentation of failure of surgery(83%) neurovascular injuries(98%). Poorly documented risk factors included mortality(21%), prosthetic dislocation(14%) and limb length discrepancy(6%).
Following the latest cycle, the trust has now approved the use of 2 consent-specific stickers(arthroplasty/fixation), amendable on a patient-to-patient basis. As part of the multi-loop process, the cycle will be repeated every year-in line with Junior Doctor rotations. Medical professionals have an ethical, moral and legal obligation to ensure they provide all information regarding surgical interventions to aid patients in making an informed decision.

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