Can a Nurse Witness a Surgical Consent Form Before the Anesthetist Has Seen the Patient?

Jane C. Rothrock, DNSc, MSN, BSN,CNOR, FAAN

Disclosures

September 21, 2004

Question

I have a question regarding the safe and ethical care of patients. In my institution it is routine for the nurse to witness the anesthesia consent form prior to surgery. We have the patient read the form or we are to read the form to them. We have the consent signed prior to anyone from the anesthesia department seeing the patient. Is this safe and ethical?

Response From the Expert

Jane C. Rothrock, DNSc, MSN, BSN, CNOR, FAAN
Professor and Director of Perioperative Programs, Delaware County Community College, Media, Pennsylvania. Dr. Rothrock's courses include entry-level perioperative nursing for RNs, RN first assistants, and for advanced practice nurses, as well as for those who are certified in perioperative nursing [CNOR]. She is a past-President of AORN, the Association of periOperative Registered Nurses.

The legal doctrine of informed consent requires the health professional -- in this case the anesthesia provider -- to not only obtain consent for anesthesia, but to also engage in a meaningful exchange of information and discussion with a patient. This legal interpretation originates in the concept of battery, which is essentially the intentional "touching" of another person without that person's consent.[1] Thus, before the anesthesia provider (or any other healthcare provider) performs a procedure, they must be given consent for the procedure that is to be performed.

Consent also has fundamental values associated with it. In part, it is underpinned by respect for the individual patient, the patient's rights, and the ability to self-determination.[2] The Patient Care Partnership: Understanding Expectations, Rights and Responsibilities (which updates the Patient Bill of Rights and may be downloaded as a brochure in several languages) addresses this somewhat in the section "Discussing your medical condition and information about medically appropriate treatment choices." This section states that in order to make informed decisions with the physician, a patient needs to understand:

  • The benefits and risks of each treatment;

  • Whether the treatment is experimental or part of a research study; and

  • What the patient can reasonably expect from the treatment and any long-term effects it may have on quality of life.[3]

Inherent in this statement outlining a patient's right to make informed decisions is the notion that opportunity will be provided for a discussion and exchange of information related, in this case, to the administration of anesthesia. Such discussion should include the options for the type of anesthesia to be administered, its risks and benefits, and reasonable alternatives. For example, some patients do not wish to be "awake" even if regional anesthesia is a viable option. The patient has the right to discuss this wish with the anesthesia provider so they can plan together the course of anesthesia care.

 

 

In most instances, the healthcare provider who ordinarily administers the anesthetic is responsible for providing sufficient information to obtain informed consent. It is true that an anesthesia provider who is not the individual who will be administering the anesthetic during the surgical intervention may obtain anesthesia consents. This process has developed primarily because of preadmission routines. The scheduling of the anesthesia provider to a specific surgical intervention cannot be done easily until the evening before or the day of surgery.

 

 

Nonetheless, the bottom line is that only an anesthesia provider would be able to give an explanation sufficient enough to be considered an informed consent. In the situation you describe, no anesthesia provider has seen the patient. Having the patient read the form, prior to being seen by the anesthesia department, or reading the form to them, does not suffice to provide the meaningful exchange of information about not only the anesthetic plan of care, but also its purpose, risks, consequences, and available alternatives.

 

 

After a patient has been seen by the healthcare provider performing the procedure (in this instance, administering the anesthesia), a nurse may obtain the patient's signature on a consent form. In such an instance, the nurse is not being asked to provide the information necessary for the patient to grant informed consent. Rather, the nurse is merely acting as a witness to the patient's identity and to the patient's signature on the form. When a nurse is present at the time a patient signs a consent form, it is a good opportunity to assess the patient's level of understanding and determine whether the patient wishes to speak further with the anesthesia provider before the surgery.

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