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Abstract
Background and aims Consenting patients for regional blockade is an essential part of orthopaedic anaesthesia. Documentation of consent is also important and is enshrined in guidelines e.g. the Association of Anaesthetists of Great Britain & Ireland’s ‘Consent for Anaesthesia 2017’.
We aimed to investigate, amongst our elective orthopaedic population, the quality of spinal anaesthesia consent documentation. We subsequently aimed to improve this using a spinal consent sticker.
Methods We retrospectively identified patients undergoing spinal anaesthesia for primary total hip and knee replacements within our district general hospital in October 2018. Consent documentation and discussed risks were compared to the 2014 Royal College of Anaesthetists’ document ‘Your Spinal Anaesthetic’. Documentation of risk of itch was not considered as our local practice avoids intrathecal opiates.
Following initial results, a sticker was introduced to attempt to improve best-practice adherence. Further data was collected in February 2019. Statistical analysis used Fisher’s exact Test. Ethics approval was not required, as per NHS Health Research Authority decision tools.
Results Forty-five patients were initially identified. In 16% there was no documentation of any consent discussion. Risks of spinal anaesthesia were also poorly documented, e.g. the most commonly documented risk (nerve damage) was written in only 40% of cases. No patient had all predefined risks documented. Reaudit following sticker introduction identified 40 patients and demonstrated a marked increase in documentation rates of all studied domains. This is shown in figure 1.
Conclusions Documentation of consent discussions is frequently done suboptimally; however marked improvement can be shown through using a simple sticker.