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Patients with diabetes are at increased risk of adverse postoperative outcomes. Pathways of care providing proactive preoperative interventions to promote day of surgery admission and day surgery should be developed.³⁸

If needed, patients and/or advocates should have access to an interpreter wherever possible to facilitate communication.²²⁶

Support should be made available and information given should be tailored for patients with individual or special needs, and for children.²²⁷

Consent should be seen as an important part of the process of discussion and decision making, rather than as something that happens in isolation. Assessment of capacity must be time and decision specific; an individual’s capacity to make particular decisions may fluctuate or be temporarily affected by factors such as pain, fear, confusion, the effects of medication or intoxication by...

Consideration should be given to assessing a patient’s understanding of information given. At the end of an explanation, patients should be asked if they have any questions. Any such questions should be addressed fully and details recorded. If urgency allows, this is better undertaken in the presence of patient’s relative(s) or supporter(s).^184,220,221

Making decisions about treatment and care for patients who lack capacity is governed in England and Wales by the Mental Capacity Act 2005 and in Scotland by the Adults with Incapacity (Scotland) Act 2000.^155,228  All clinical staff must be familiar with, and apply the principles of, this legislation and receive training in assessment of...

Organisations must ensure that provision is made for appropriate assessments to be carried out for patients whose care falls under the Deprivation of Liberty Safeguards, as specified by the Mental Capacity Act 2005.  Provision must also be made for the involvement of independent mental capacity advocates.¹⁵⁵

An anaesthetist should preoperatively assess all patients undergoing emergency surgery who require anaesthesia. This should take place outside of the theatre complex if possible and adequate time should be available for this to occur as clinical urgency allows.¹⁸¹

A full anaesthetic management plan should be recorded in the patient's records or anaesthetic chart and initiated preoperatively.¹⁷⁶

The experience and expertise of the anaesthetist assessing the patient preoperatively should be appropriate for the complexity and level of risk of the patient.⁴⁶ The decision to operate on high risk patients should be made at a senior level, involving surgeons and those who will provide intra and postoperative care.^3,14,33