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baigmk

Consent for ECT

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Warning A long rant follows.......

It happened to me few days back. We dont have ECT facilities in my unit and our patients attend another psychiatric unit to get ECT. I have done loads of ECT in my 3 previous posts (1 session every 1-4 weeks). This patient was the first one to have ECT in my current post as she was suicidal and 2nd antidepressant had not been of much help. On ward round, my consultant asked me to discuss ECT with her and see whether she would be willing. I discussed with patient about ECT, procedure, reasons, risks, side effects, benefits, alternatives etc, gave her information leaflets, answered her questions, everything that I could do to make sure that she had all the right information. She was informal and after discussions for about one week, she agreed and I got the consent form signed. On the day of ECT when she was about to be sent to other unit, one of the nurses who organises the ECT for our unit checked the paperwork and told me that consent was not valid and patient could not go for ECT. To my surprise she said that SHO can not take consent for ECT, it has to be the consultant. I strongly disagreed, referred to the consent form, checked with unit doing the ECT, checked trust policy on ECT.......there was nothing to indicate that only consultant could take consent thought it did say that 'healthcare professional taking consent should have adequate knowledge of the procedure' which I thought I had. I had quite an argument (it was 8 30 am and I was on nights) and finally told her that I would send the patinet for ECT even if she feels that consent is invalid and sent her. She kept on screaming that its going to be my responsibility 'if something happens' but I didnt care, patient was quite unwell and I was really p*d off. I left a written message for my consultant regarding what had happened. Later she spoke to my consultant and he countersigned the consent forms and I thought why did he do it? I am close to taking my part 2 exam, have done so many ECT sessions that I started hating it, cant I take even consent for ECT? Some of the nurses (not all of them, some are brilliant) just feel that SHOs should be doing physical, sending bloods, making notes in the files during ward rounds and MDT meetings, rubberstumping their decisions and documenting those in medical notes and see patients for physical health issues. When it comes to any of the psychiatric problems, they want the consultant and only consultatn to deal with it. At times SHO would be sitting in the office but nurse would prefer to ring the consultant without even discussing the issue with SHO. It happened a lot in my last post. I was really dissapointed on this ECT issue not only with that organising nurse but also with my consultant who just accepted her argument and countersigned the forms which were already signed by me. Still on nights so have not been able to speak to him about it. Perhaps he has good reasons for that.

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Have been in your shoes before Shrek...

I think the trust policy says 'RMO or any one nominated by the RMO' in this case must have been you...

I think you are right...

[highlight]But...[/highlight]

As of now... unfortunately... defensible practice comes above patient care... we cover our backs and let the patient suffer...

So do everything you need to progress...

SMILE...

AGREE (later disagree if you want... you always have superego to come and vent out...)

Learn to ramble on....

Get your 360 degrees appraisal...

All the skills you need for career progression....

(as for knowledge, you always have the OTP, maudsley guidelines and BNF handy)

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I don't agree completely with Dorian, we should be able to hold our knowledge and experience in high esteem for ourselves. You could easily just bow to the system (as you say your consultant might have), but I think you did right by believing in your self. Of course I would like to have known the nurse's reaction if you had said to her that the responsibility would be hers if the patient got worse or hurt herself, and where was her info when you were asked in the WR?

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