Search

Patients who may require surgical procedures with DNACPR decisions in place should have senior members of the anaesthetic and surgical team review the condition of the patient and the DNACPR status. Where feasible, a discussion should take place with the patient and their next of kin and it may be appropriate to suspend components of a DNACPR decision (e.g. tracheal...

Organisations should provide up to date, reliable information resources for patients and their relatives e.g. based on literature available from the Royal College of Anaesthetists and Association of Anaesthetists.²¹⁹ It should include information about the process they will experience, and what their postoperative care will mean for them.^220,221

As part of a quality improvement programme, hospitals should develop a local understanding of the adequacy of their consent process and information supplied to patients undergoing emergency surgery, by proactively seeking patient feedback and allocating appropriate resources to this process.²⁰⁷

Organisations should have clear guidance, policies and training for all staff taking consent, which is in accordance with GMC guidance. Anaesthetists must work in partnership with patients and other healthcare professionals, to ensure good care guided by the principles listed next.²²²

• Healthcare professionals should assume patients have capacity to make decisions until assessed and proven otherwise. Clinicians should...

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...