Recording consent and consent forms
The presence of a signed consent form does not in itself prove valid consent to treatment
Apart from certain treatments carried out under the Mental Health Act and some forms of fertility treatment, there is no legal requirement to obtain written consent, but most health organisations, including NHS trusts, independent hospitals and primary care trusts, have policies stipulating when written consent should be obtained. Employees are expected to be familiar with these and adhere to them.
The presence of a signed consent form does not in itself prove valid consent to treatment – the important factors will always be the quality, extent and accuracy of the information given beforehand. Being able to demonstrate this afterwards depends on contemporaneous notes recording the key points discussed and relevant warnings given to the patient.
Scenario 5
Mr S attends the A & E department of his local hospital with a severe allergic reaction thought to be from an insect bite. In addition to topical applications, he is given antihistamines. The following day he is involved in a road traffic accident, having failed to stop at a road junction. He claims that he was not informed that the medication could cause drowsiness and that it would be inadvisable for him to drive. But the doctor at the hospital is adamant that appropriate warnings were given. However, these were not recorded in the notes.
Mr S subsequently makes a claim and the trust’s solicitors advise settlement as they would be unable to prove that appropriate warnings were given.