A quality improvement project – Improving consent for procedures carried out in oral and maxillofacial surgery

Title : A quality improvement project – Improving consent for procedures carried out in oral and maxillofacial surgery

Abstract:

Royal College of Surgeons place emphasis on the importance of full, accurate and legible completion of consent forms as an important part of the process of gaining informed consent. Consent forms completed in the outpatient setting in the oral and maxillofacial department were at Worcestershire Acute hospitals NHS trust were not adequately completed in certain circumstances. A Quality Improvement Project was undertaken to improve the completion of consent forms within the department.

Baseline information on completion of: (1) patient details, (2) consultant details, (3) legibility, (4) use of abbreviations in description of operation/complications, and (5) patient signatures was collected. 50 patients undergoing elective and emergency oral maxillofacial procedures were randomly identified over a two month period. 4 PDSA cycles were undertaken which included targeted teaching to dental core trainees and juniors in the department on use of consent forms, proforma and consent aide sheets placed in clinics to aid consent from clinicians, consent form aid prompts with common risks and complications, reminder emails, messages on watsapp, discussion at departmental meetings and the introduction of consent form stickers.

Baseline data collection include: 20% were noted to have inadequate complications listed (score 0 [>5 risks missing) when compared to the standard.  25% were noted to have inadequate benefits discussed. 90% of consent forms had a legible clinician or patient signature. Adequate procedural details were present in 100%. Full consenter details including clinician signature and data were present in 70%. 70% of the consent form copies were offered or given to the patients.

Outcome measure 1 (legibility of documentation) increased from 62% to 100% and on the reaudit months later was sustained at 100%. Outcome 2- benefits of a score of 3 was noted from 75% to 100%. Patient signature, name and dating) rose from 90% to 100% The documentation of risks/complications of a score of 3 rose from 80% to 100%.100% of consent forms were now offered to patients, increasing from 40%. Documentation of patient details started at 95% and steadily increased to 100% over the 4 cycles and remained at 100% throughout the QI project.

Conclusion: This QIP project has shown significant improvements in the quality of consent form completion. These improvements, and the discussion that the project has provoked within the oral and maxillofacial department, are likely reflective of improvements in the process of taking consent which is of benefit to patients and clinicians.

Biography:

Nitesh Kumar Graduated from the University of Dundee in 2016 and was recipient of the Dundee dental materials den and St Andrews Dental Alumni Prize 2015. Following post graduate training in the North east of Scotland Aberdeen, worked in oral and maxillofacial units where he can manage medically compromised, head and neck cancer patients and acute OMFS emergencies, has experience with complex oral surgery at University Hospital Southampton NHS foundation trust and Worcestershire Acute general hospital trust hospitals, Musgrove park hospital.  He has presented at national and international oral surgery and maxillofacial conferences and has publications in peer reviewed journals. He has undertaken many clinical governance projects during his rotations in Oral and Maxillofacial surgery.