The seeking and giving of consent is usually a process, rather than a one off event. For major interventions, it is good practice, where possible to seek the patient’s consent to the proposed procedure well in advance, when there is time to respond to the patient’s questions and provide adequate information. The information the patient needs to make informed consent should be given at that time, thus allowing an opportunity for reflection by the patient and if necessary they may seek additional information or change their mind.

In NHS Ayrshire & Arran signed consent forms will be considered valid for 182 days (26 weeks). If the consent form was signed >84 days (12 weeks) before the operation, it is mandatory to obtain a further signature from the patient confirming that they still wish to proceed (part C of the standard consent form). This may require further discussion with the patient about the procedure, benefits, risks and alternatives, as guided by the patient’s wishes. Some health professionals may wish to use the confirmatory signature at earlier times. The confirmatory section should also be used, if the operator is different from the health professional who took consent (for example, because of unplanned absence).

If the patient is not asked to give consent until just before the procedure is due to start, at a time when they may be feeling particularly vulnerable, there may be real doubt as to the validity of the consent.

• For inpatients, with the exception of emergency situations, ward nursing staff must not release the patient to go to theatre reception unless a valid consent form has been completed.
• With the exception of emergency situations, theatre reception nursing staff must not release the patient to the theatre unless a valid consent form has been completed.
• Patients must not be given pre-operative sedation before being asked for consent to proceed with the treatment.
• If it is found that consent was not obtained prior to the administration of sedation the procedure must not go ahead and will require to be re-scheduled as consent will not be valid.

3.2.1 One-stop treatments or procedures

Consenting patients on the day of the procedure is unlikely to give adequate time for the patient to make a considered choice for anything other than low risk, simple procedures. Clinical urgency is one justification, where the patient’s safety would be compromised by delay.

Some high volume, low risk procedures are offered in NHS Ayrshire & Arran as one-stop services, for example cataract surgery and endoscopy. NHS Ayrshire & Arran will produce written or audio information packs, which will be sent to patients prior to the treatment, and this will, where appropriate, be supplemented by a telephone pre-operative discussion by a suitably trained nurse. On the day they attend for the treatment, consent will be obtained.

After discussion at the relevant clinical governance meeting, departments must seek approval for same day consent from the Surgical Division Clinical Governance Group. Departments should regularly (at least every three years) assess whether the information provided and the approach to consent is satisfactory, by engaging with patients who have experienced the procedure. The outcome of these surveys should be reported through the clinical governance structures.