scholarly journals 202 Consenting Practice for Post-Cholecystectomy Diarrhoea After Laparoscopic Cholecystectomy – Are We Missing A Trick?

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
K Matwala ◽  
M R Iqbal ◽  
T Shakir ◽  
S Karamanakos
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Healthcare Professionals ◽  
Chronic Diarrhoea ◽  
Health Board ◽  
Consent Forms ◽  
Consecutive Period ◽  
Elective Laparoscopic Cholecystectomy ◽  
Assess Quality ◽  
The Uk

Abstract Aim The landmark case of Montgomery v Lanarkshire Health Board led to the defensive Bolam test being discredited and paved the way healthcare professionals (HCP) obtain informed consent. The recent GMC guidance on Decision Making and Consent 2020, states that the HCP should discuss recognised risks that they believe anyone in the patient’s position would want to know. Laparoscopic cholecystectomy is one of the most common general surgical procedures performed in the UK. Chronic diarrhoea is a well-recognised complication with significant impact on patient quality of life (QoL). We aimed to assess quality of consent forms for laparoscopic cholecystectomies with emphasis on documentation of chronic diarrhoea being a consequence of the procedure. Method A retrospective review of all elective laparoscopic cholecystectomy consent forms over a 2-month consecutive period from July 1st 2020 to August 31st 2020 was carried out. Results 43 consent forms were audited. The majority of these consent forms were done by consultants (74.4%: 32/43) while 23.2% (10/43) by registrars. Overall, 39.5% (17/43) of patients were consented for experiencing chronic diarrhoea. Registrars more commonly mentioned diarrhoea (60%: 6/10) compared to consultants (31.2%: 10/32). Conclusions The majority of patients undergoing laparoscopic cholecystectomy are not consented for post-cholecystectomy diarrhoea which is a significant QoL-altering complication. Education combined with a standardised consent form and issuing of patient leaflets will improve consenting for chronic diarrhoea.

Person-centered support for adults with learning difficulties: an evaluation

2016 ◽  
Vol 4 (2) ◽  
pp. 384
Author(s):  
Roger Ellis ◽  
Elaine Hogard ◽  
Juli Carson
Keyword(s):  
Quality Of Life ◽  
Social Services ◽  
Care Staff ◽  
Service Users ◽  
Block Grant ◽  
Stakeholder Perspectives ◽  
Assess Quality ◽  
The Uk ◽  
Individual Service

This paper describes an evaluation of a Personalisation Programme provided by the UK Charity Choice Support for adults with learning difficulties.Personalisation, synonymous with patient-centred care, means thinking about care and support services in an entirely different way. This involves starting with the person as an individual with strengths, preferences and aspirations and putting them at the centre of the process of identifying their needs and making choices about how and when they are supported to live their lives. It requires a significant transformation of adult social care so that all systems, processes, staff and services are geared up to put people first.The Choice Support Personalisation Programme had three main features: Person Centred Planning; Individual Service Funds and Better Nights, a new form of night support which encourages greater independence. Person Centred Planning means exploring in detail what each individual wants and needs and planning support accordingly. An Individual Service Fund represents a notional allocation of money to each individual for support based on individual need and preference as opposed to a block grant and a standard support for all. Better Nights was a shift from ‘Waking Nights’ with support staff available and monitoring individuals throughout the night to ‘Sleep In’ where the care staff followed normal waking and sleeping patterns together with the individuals thus encouraging a more normal life style with greater independence. The Social and Health Evaluation Unit (SHEU) of the Buckinghamshire New University, UK, has completed two programme evaluations; one of Better Nights and one of personalisation more broadly. In each case the Unit’s Trident method was used focusing evaluation questions on outcomes; process and stakeholder perspectives. Data from the evaluation were assessed together with the substantial savings achieved. Specially devised audit tools were used to assess quality of life and risk management. Overall the results of these audits showed a maintenance or improvement in quality of life for the service users and effective management of risks. The process of implementation was described in sufficient detail to allow replication, learning and continuous improvement. Stakeholder perspectives were surveyed from care staff, parents and relatives and social services staff. Overall the programme had achieved its stated outcomes in person-centred care with substantial savings. For the minority of service users whose quality of life did not appear to improve, further detailed analysis and planning is being undertaken.

Informed consent, Montgomery and the duty to discuss alternative treatments in England and Australia

2020 ◽  
Vol 25 (5) ◽  
pp. 187-193
Author(s):  
Tracey Carver
Keyword(s):  
Information Disclosure ◽  
Healthcare Professionals ◽  
Treatment Options ◽  
Case Law ◽  
Health Board ◽  
Alternative Treatments ◽  
Recommended Treatment ◽  
Uk Supreme Court ◽  
The Uk ◽  
Treatment Risks

The UK Supreme Court in Montgomery v Lanarkshire Health Board imposes a duty on healthcare professionals in relation to information disclosure. The obligation is to take reasonable care to ensure that patients are aware, not just of material risks inherent in any recommended treatment, but of any reasonable alternative treatments. While liability for information non-provision was previously decided according to whether the profession would deem disclosure appropriate, the law now judges the sufficiency of information from a patient’s perspective. In doing so, it adopts the approach advocated for Australia in Rogers v Whitaker. However, commentators, in this journal and elsewhere, have expressed concern that the disclosure obligation is unclear. Although Montgomery defines what is ‘material’ for the purpose of identifying notifiable treatment risks, it offers less guidance as to when alternative treatments will be sufficiently ‘reasonable’ to warrant disclosure. Through an analysis of Australian and UK case law and examples, this article considers the ambit of a practitioner’s duty to discuss alternatives. It concludes that although likely subject to further litigation, the identification of reasonable treatment options requiring disclosure will be influenced by the patient’s clinical condition, their prognosis and viable options from a medical perspective, and various non-clinical matters influenced by the test of materiality.

scholarly journals Current use of procedure specific consent forms for laparoscopic cholecystectomy

2018 ◽  
Vol 100 (6) ◽  
pp. 446-449 ◽  
Author(s):  
MJ Courtney ◽  
TJ Royle
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
National Health Service ◽  
Bile Duct ◽  
Informed Consent Process ◽  
Freedom Of Information ◽  
General Anaesthetic ◽  
Consent Forms ◽  
Information Request ◽  
Current Usage

Introduction Procedure specific consent forms (PSCFs) have been shown to improve consenting practice for a standardised list of complications. The aim of this study was to assess the current usage and quality of PSCFs in the National Health Service (NHS) for cholecystectomy, specifically comparing the listed complications with those mentioned on the NHS website. Methods A freedom of information request was sent to all NHS trusts asking whether they perform laparoscopic cholecystectomy and whether they have a PSCF for this. A copy of the PSCF was also requested. Complications stated on these forms were compared with those on the NHS Choices website. Results Overall, 162 (88%) of the 185 trusts responded, with 121 of these performing cholecystectomies. Among these, 20 (17%) currently use PSCFs; all provided a copy. Five (25%) of the PSCFs contained all eight risks mentioned on the NHS website. The number of risks listed varied from 4 to 18 per form. Only bile duct injury was listed on every PSCF. The least frequently mentioned complication (45% of forms) was the risk from general anaesthetic. Conclusions This study suggests that too few trusts are using PSCFs and that those PSCFs that are in use contain too little detail on the risks of cholecystectomy. The listed risks and incidences on each PSCF were highly variable. More trusts should begin to use PSCFs during the informed consent process and each PSCF should include a nationally standardised list of potential complications to act as a prompt for discussion (and documentation) of risk.

scholarly journals EP.TH.342Using aboutmyop.org to measure quality of life using ePROMs in patients undergoing elective laparoscopic cholecystectomy – a feasibility study

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Prita Daliya ◽  
Dileep Lobo ◽  
Simon Parsons
Keyword(s):  
Quality Of Life ◽  
Laparoscopic Cholecystectomy ◽  
Methodological Quality ◽  
Clinical Care ◽  
Well Being ◽  
Drop Out ◽  
Digital Data ◽  
Patient Reported ◽  
Elective Laparoscopic Cholecystectomy

Abstract Introduction The collection of Patient Reported Outcome Measures (PROMs) have many benefits for clinical practice. However, there are also many barriers that prevent it from becoming a part of routine clinical care. The aim of this study was to pilot the use of aboutmyop.org; a digital data-sharing platform, as a means to collecting electronic PROMs (ePROMs) and validate the ePROMs questionnaires used. Method Patients listed for elective laparoscopic cholecystectomy were asked to complete digital versions of the Otago gallstones Condition-Specific Questionnaire (CSQ), and the RAND 36-item health survey (SF36) on aboutmyop.org, pre- and post-operatively. In addition to ePROMs, patient demographics and 30-day clinical outcomes were recorded. An assessment of methodological quality of ePROM questionnaires was also performed. Results Pre-operative ePROMs were completed in 200 laparoscopic cholecystectomy patients. Despite participant drop out a significant improvement in quality of life was seen across all health domains post-operatively when compared to baseline pre-operative values for both disease-specific (emotional functioning; Pre-operative: 48.9, 30-days: 15.6, 3-months: 16.7, 6-months: 7.9, p < 0.05) and generic (emotional well-being; Pre-operative: 60.1, 30-days: 73.7, 3-months: 74.3, 6-months: 73.5, p < 0.05) PROMs. Methodological quality was assessed as good to excellent in both digital questionnaires used in the aboutymyop.org system. Conclusion The collection of ePROMs by a digital utility such as aboutymyop.org is possible with current technological advances. Although it may be an acceptable, and convenient process for patients, and a useful measure of quality of life trends for clinicians, further developmental work is necessary to improve accessibility for patients and reduce reporting bias.

scholarly journals A STUDY OF PORT SITE INFECTION AFTER LAPAROSCOPIC CHOLECYSTECTOMY

2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Mahesh Joshi ◽  
Prama Dubey
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Quality Of Healthcare ◽  
Port Site ◽  
Site Infection ◽  
Proper Selection ◽  
Basic Principles ◽  
Elective Laparoscopic Cholecystectomy ◽  
Selection Of Patients ◽  
Selection Of

Background: Port site infections though rare, shall be evaluated and studied so as to improve the quality of healthcare. Materials and Methods: This prospective study was conducted on100 patients of all age group and both sexes with symptomatic cholelithiasis undergoing laparoscopic cholecystectomy were analysed for port site infection. Result:   Out of 100 patients studied only 3 patients presented with port site infection. Conclusion: It is concluded that port site infection are rare in elective laparoscopic cholecystectomy and can be further reduced by proper selection of patients, and strictly following basic principles of laparoscopic cholecystectomy Keywords: Port site infection, laparoscopic, Cholecystectomy

scholarly journals A STUDY OF PORT SITE COMPLICATIONS AFTER LAPAROSCOPIC CHOLECYSTECTOMIES AT TERTIARY CARE HOSPITAL IN WESTERN RAJASTHAN

2019 ◽  
Vol 3 (7) ◽  
Author(s):  
Surendra Saini ◽  
Manish Kumar Saini
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Tertiary Care ◽  
Quality Of Healthcare ◽  
Port Site ◽  
Care Hospital ◽  
Medical College ◽  
Port Site Hernia ◽  
Elective Laparoscopic Cholecystectomy

Background: Port site complications though rare, shall be evaluated and studied so as to improve the quality of healthcare. Materials and Methods: This prospective study was conducted in the Department of General Surgery, Sardar Patel Medical College & P.B.M. Hospital, Bikaner, Rajasthan. 200 patients of all age group and both sexes with symptomatic cholelithiasis undergoing laparoscopic cholecystectomy. Result: Out of 200 patients studied only 1 patient presented with port site hernia in the follow up and 13 patients presented with port site infection. No other complication was detected   after laparoscopic cholecystectomies. Conclusion:  It is concluded that port site complications are rare in elective laparoscopic cholecystectomy and can be further reduced by proper selection of patients, and strictly following basic principles of laparoscopic cholecystectomy. Keywords: Laparoscopic surgeries, Port site infections, Complications

SP7.2.7 Consenting practice in open inguinal hernia mesh repair and compliance with the British Hernia Society Standards

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Janine Adedeji ◽  
Charlotte Binnie ◽  
Khaled Noureldin ◽  
Amira Shamsiddinova ◽  
Bandipalyam Praveen
Keyword(s):  
Inguinal Hernia ◽  
Postoperative Complications ◽  
Wound Dehiscence ◽  
Prolene Mesh ◽  
Consent Forms ◽  
Information Leaflets ◽  
Retrospective Audit ◽  
The Uk ◽  
Hernia Mesh Repair

Abstract Aims Inguinal hernia repairs (IHRs) are one of the most frequently performed procedures worldwide with approximately 100,000 taking place in the UK each year. This study analyses open IHR consent practice against British Hernia Society standards, in particular, whether the term ‘mesh’ and significant postoperative complications were stated on consent forms. We also identified whether adequate post operative advice was given upon discharge in order to prevent recurrence. Methods This was a retrospective audit of all patients above 18 years old, who underwent open IHR 1 January - 31st December 2019. A total of 94 patients were included. Results Although in all cases a prolene mesh was inserted, 8.5% of patients received no mention of mesh in either the clinic letter or consent form. Postoperative readmission was 5.3% at one week, and 8.5% at one month. Reasons for readmission included pain (1%), haematoma (2%), and wound dehiscence (1%). In over 90% of consent forms, non-specific complications (bleeding, infection) were documented. However, common IHR postoperative complications, such as chronic pain (not mentioned in 15%), were not mentioned in consent forms. Only 38% of patients received written postoperative advice. Conclusion Adherence to consenting standards benefits both patients and doctors. Our study highlights that further intervention is required to ensure surgeons are consenting patients adequately, as well as providing sufficient postoperative advice. We advise use of pre-filled forms and patient information leaflets, both in line with GMC guidance, to improve the quality of service offered.

Stomas

2021 ◽  
pp. 175573802110322
Author(s):  
Michael Thomas ◽  
Ailsa MacLean ◽  
Benjamin McDermott ◽  
Jonathan Epstein
Keyword(s):  
Quality Of Life ◽  
Patient Care ◽  
Abdominal Wall ◽  
Healthcare Professionals ◽  
Anterior Abdominal Wall ◽  
Hollow Viscus ◽  
Stoma Formation ◽  
The Uk ◽  
The Impact

A stoma is a surgically created opening between a hollow viscus and the skin. Abdominal stomas are used to divert the flow of bowel contents or urine into a bag attached to the skin of the anterior abdominal wall. It is estimated that 1 in 500 people in the UK are currently living with a stoma, and approximately 13 500 people undergo stoma formation every year. Understanding why patients have stomas, how these should be managed, and what potential complications may arise from their formation can help healthcare professionals to provide safe and effective patient care. It is also important to appreciate the impact of a stoma on a patient and how this may affect quality of life.

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