How well are we Involving Children and Young People (adolescents) in Consent to their Surgery? An Audit of Practice

Background: It is good practice to involve children and young people (CYP) in consent to treatment. 16-17 year olds are presumed to have capacity. The Royal National Orthopaedic Hospital is a specialist centre performing complex often high risk orthopaedic surgery on CYP , a high proportion of which are adolescents and vulnerable children .

Objectives: We sought to find out how many children are involved in the consent process, if mental capacity was assessed and if parental responsibility was documented with a view to improve the quality of the consent process.

Methods: A retrospective audit of electronic notes of children admitted in August 2018.

Results: 108 patients assessed. 22 (20%) were 16-17 year olds , 78 (72%) were 10-17 year olds (adolescents) . 72% of 16-17 year olds countersigned forms but parents gave primary consent . Only 4% of 16-17 year olds gave primary consent with parents counter signing. Involvement increased with age : 50% of 10 year olds ; 80% of 17 year olds countersigning forms. Senior doctors gained informed consent- 70% being consultant or registrar level. Mental capacity assessment ( MCA) was not documented . Parental responsibility was assessed 94% of the time. Only 1 child may have lacked capacity; consent was signed by parents and MCA was not documented.

Conclusion: we are involving CYP in consent to surgery but can improve numbers signing consent forms and documentation of MCA. We have tackled this by educational interventions to doctors seeking consent ; a short film with adolescent involvement aimed at CYP and their families ; an opt out policy of consent rather than opt in by using form 1 (primary consent to treatment) in 16-17 year olds rather than form 2 (parental consent ) and added MCA documentation in the admissions booklet and will re-audit .