Communication 
Complication Post Procedure

Scenario

10 Minutes

 

You are asked to see Emma who is a 13-year old girl who had come in for a removal of metalwork from her right distal radius. She is now several months post-operatively and has come with her mother today who is slightly apprehensive about the surgery.

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How would you consent this patient for theatre?

 

Consenting the Patient for Theatre:

1. Establish rapport: Begin by introducing yourself and ensuring both Emma and her mother are comfortable. Address any concerns or questions they may have before proceeding with the consent process.

2. Explain the procedure: In simple terms understandable to Emma, describe the process of removing the metalwork from her wrist. Highlight that the surgery aims to improve her wrist function and that it's a relatively routine procedure.

3. Discuss benefits: Emphasise the benefits of improved wrist function and reduced risk of long-term complications associated with retaining the metalwork.

4. Discuss risks: specific risks include pain, infection, bleeding, scarring, neurovascular injury, metalwork breakage, incomplete removal, tendon / ligament injury anaesthetic risks

5. Answer questions: Encourage Emma and her mother to ask any questions they may have about the procedure, risks, or recovery process. Address each question with patience and clarity.

6. Ensure understanding: Confirm that Emma and her mother understand the information provided. Use open-ended questions to assess their comprehension and address any remaining concerns.

7. Obtain consent: Once Emma and her mother feel informed and comfortable with the proposed procedure, provide them with the consent form to sign. Clearly explain that signing the form indicates their agreement to proceed with the surgery.

 

What consent form would she require?

 

For Emma's surgery, you would require a consent form 2 specifically tailored for minors undergoing medical procedures. This form should outline the details of the surgery, potential risks and benefits, alternatives, and any special considerations related to Emma's age and medical condition. It should also include space for Emma's mother, as her legal guardian, to provide her signature consenting to the procedure on Emma's behalf.

 

What do you understand by the term Gillick Competence?

 

• Gillick competence refers to the legal concept that allows minors to consent to medical treatment without parental consent

• They must demonstrate sufficient understanding and maturity to make informed decisions about their healthcare.

• In the context of Emma's case, while she is 12 years old, if she demonstrates the capacity to understand the proposed surgery and its implications, she may be deemed Gillick competent, allowing her to provide consent alongside her mother.

 

During the procedure you accidentally injure the radial artery, fortunately, this was repaired intra-operatively by the vascular surgeons. One of the nurses has informed Emma's mother and she is very distressed. How would you face this situation when speaking to her mother afterwards?

 

Using the SPIKES protocol for delivering difficult news:

 

Setting

Ensure privacy and a comfortable environment for the discussion. Find a quiet room where Emma's mother, Mrs. Thompson, can sit down and focus without interruptions.

 

Perception

Begin by gauging Mrs. Thompson's perception of how Emma's surgery went. You might say, "Mrs. Thompson, how do you feel about Emma's surgery today? Do you have any concerns or questions about how it went?"

 

Invitation or Information

Provide Mrs. Thompson with a brief overview of what happened during the surgery. You could say, "I want to update you on Emma's surgery. During the procedure, there was an unexpected complication. The radial artery in Emma's wrist was accidentally injured. However, I want to assure you that our team acted swiftly to repair the artery while Emma was still under anesthesia."

 

Knowledge

Explain to Mrs. Thompson what this complication means for Emma's recovery. You might say, "Emma's radial artery is an important blood vessel that supplies blood to her hand. While the injury was repaired during the surgery, we will need to closely monitor Emma for any signs of reduced blood flow or other complications in her hand. Our team will continue to provide Emma with the best possible care to ensure her recovery."

 

Empathy

Express empathy and support for Mrs. Thompson and Emma during this challenging time. You could say, "I understand that this news may be concerning for you, Mrs. Thompson. Please know that our priority is Emma's well-being, and we're here to support both of you every step of the way."

 

Summarize or Strategize

Summarize the key points of the discussion and offer a plan for next steps. You might say, "To summarize, Emma's surgery had a complication involving her radial artery, but it was repaired successfully. We will closely monitor Emma's recovery and provide any additional care she may need. If you have any questions or concerns at any time, please don't hesitate to reach out to me or our team."

 

By following the SPIKES protocol, you can effectively communicate the complication to Mrs. Thompson with empathy and clarity, ensuring she feels supported and informed during this difficult time.

 

How do you ensure clear documentation and communication of the complication, the steps taken to address it, and any follow-up care required?

 

To ensure clear documentation and communication of the complication, the steps taken to address it, and any follow-up care required, I would:

• Document the details of the complication: including the timing, nature, and severity of the radial artery injury, as well as the intra-operative repair procedures performed.

• Clearly outline the post-operative management plan: including any specific monitoring requirements, medications prescribed, and follow-up appointments scheduled.

• Communicate the information: promptly and accurately to all relevant members of the healthcare team, including nurses, anaesthesiologists, and other specialists involved in Emma's care.

• Encourage open communication and collaboration: among team members, ensuring that any questions, concerns, or changes in Emma's condition are promptly addressed and documented.

 

How would you prevent, as the operating surgeon, this complication from happening in the future?

 

As a surgeon, preventing complications involves a comprehensive approach that prioritises patient safety and continuous improvement. Everyone has complications as a trainee and the important thing is to be able to learn from it and prevent from happening in the future. Here's how I would address and mitigate the risk of similar complications:

 

1. Reflect on the Case: Following Emma's surgery, I would take time to reflect on the factors that may have contributed to the accidental injury to her radial artery. This includes reviewing the surgical technique, anatomy, decision-making processes, and any other relevant factors that could have played a role in the complication.

2. Revisit Surgical Techniques: I would thoroughly review and reassess the surgical techniques used during procedures similar to Emma's. This may involve revisiting anatomy landmarks, ensuring proper identification of vital structures, and employing meticulous surgical skills to minimise the risk of unintended injuries with adequate retraction.

3. Discuss with Consultants and Seniors: I would seek input and guidance from experienced colleagues, consultants, and senior surgeons within the department. By discussing the case with them, I can gain valuable insights, learn from their experiences, and incorporate their recommendations into my practice to enhance patient safety.

 

Finally state you would perform a PBA or journal entry to reflect on the case and identify strategies to avoid this complication in the future.

 

What do you understand by a surgeon duty of candour?

 

The duty of candour requires surgeons to be open, honest, and transparent with patients and their families about adverse events, incidents, or errors that occur during medical care.

 

Key Aspects of Duty of Candour:

1. Disclosure: Surgeons must promptly inform patients or their representatives about adverse events, incidents, or errors in a transparent manner.

2. Apology: Offering a sincere apology demonstrates empathy, accountability, and a commitment to addressing the situation with integrity.

3. Support: Surgeons should provide appropriate support and assistance to patients or their representatives following adverse events, incidents, or errors.

4. Documentation: Accurate and comprehensive documentation of adverse events, incidents, or errors is essential for accountability and learning within healthcare organizations.

 

This ethical obligation promotes transparency, trust, and accountability in healthcare relationships and fosters a culture of safety and learning within healthcare organisations.