Tuesday, 21 November 2017

Patient information and consent

Information in this context includes information related to the endoscopic procedure and should include why the procedure is being done, what it involves, preparation for the procedure, and the risks. The patient should be told what he/she might expect to happen after the procedure (including contact details in case of emergency) and the plan of aftercare. The patient should be informed about the options for sedation and how this might affect their perception of the procedure and the associated restrictions on travelling home.

The consent process involves an explanation of the procedure, the potential benefits, the risks and possible consequences. Consent for endoscopic procedures begins with a recommendation to have the examination, and ends when the procedure is complete. The individual must have the opportunity to withdraw consent at any stage during this process. 

The key elements of patient information for endoscopy include: 

  •  considerations related to current medications including anticoagulants and antiplatelet agents;
  • considerations related to previous medical illnesses;
  •  the benefits of the test; how to prepare for the procedure (including bowel cleansing); 
  •  the nature of the procedure and what it involves;
  •  possible adverse events including discomfort and complications; 
  •  what support the patient may need after the procedure, particularly if they are sedated; 
  • and the importance of not driving or making important decisions after sedation. 

Auditable outcomes: patient feedback on information and consent processes. These assessments should ideally be both qualitative and quantitative and make an assessment of the patient experience judged by the gap between the expectation and actual experience. Withdrawal of consent should be registered as an adverse clinical incident. 


The purpose of pre-assessment is to identify factors that might influence the outcome of the procedure, such as anticoagulation and general health status. Pre-assessment also provides an excellent opportunity to ensure the patient understands the bowel cleansing process and to answer any questions the patient may have.

The nature of the pre-assessment will depend on whether there has been prior contact with an endoscopy service health professional. If there has been no prior contact with the service, it is advised to pre-assess the patient several days before the procedure, at least before starting bowel cleansing. This will enable the procedure to be rescheduled if there are concerns about safety, or for medication such as warfarin to be withdrawn in sufficient time to allow its anticoagulant effect to wear off. 

Available evidence (Bini et al. 2003; Hui et al. 2004; Bernstein et al. 2005; Harris et al. 2007a; Lee et al. 2008; Tsai et al. 2008) suggests that the following patient-related variables should be identified and taken into account prior to FS or colonoscopy because they can be associated with more adverse events, longer duration, and incomplete examination: 

Use of anticoagulants e.g. warfarin; 

  •  Anatomy (female sex); 
  •  Age of patient; 
  •  Prior abdominal surgery;
  •  BMI; 
  •  Diverticular disease; 
  •  ASA PS (American Society of Anesthesiology classification of Patient Status)2 and information that may influence type and level of sedation (for those procedures where sedation may be used); and 
  •  Presence of risk factors for endocarditis
On the day of the procedure there should be a brief review of the previously collected information and measurement of basic cardio-respiratory function

Auditable outcomes: Recording and review of adverse clinical events related to inadequate preassessment (e.g. anticoagulants not stopped or risk factors for endocarditis not identified) 

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