TBA (18A190)

A Survey of Irish Rheumatologists’ Practice for Documenting Informed Consent for Corticosteroid Injections

Author(s)

J Ralph, R Carson, A Azhar, P O’Connell

Department(s)/Institutions

Department of Rheumatology & Rehabilitation, Beaumont Hospital, Dublin 9

Introduction

Corticosteroid injection is a common therapeutic intervention for symptomatic joint and soft tissue disorders. Whilst minor local side-effects are possible, serious complications (e.g. septic arthritis) are rare. Nonetheless, recording informed consent for such procedures is a core component of safe practice. A recent audit in our unit indicated a need to improve the documentation of consent. Informal opinion favours verbal consent given the low risk involved; it is unknown to what extent standardised methods are being used nationally.

Aims/Background

Corticosteroid injection is a common therapeutic intervention for symptomatic joint and soft tissue disorders. Whilst minor local side-effects are possible, serious complications (e.g. septic arthritis) are rare. Nonetheless, recording informed consent for such procedures is a core component of safe practice. A recent audit in our unit indicated a need to improve the documentation of consent. Informal opinion favours verbal consent given the low risk involved; it is unknown to what extent standardised methods are being used nationally.

Method

59 registered rheumatologists were surveyed by anonymous postal questionnaire regarding: (i) Number of injections performed over the previous month; (ii) Use of image guidance; (iii) Any procedure-related complaints received over the previous 5 years; (iv) Current process for obtaining consent; (v) Procedural information routinely discussed with patients; (vii) Information documented in the notes

Results

44 surveys were returned (response rate 74.6%).
68% of respondents performed over 10 joint injections in the previous month. 2% used image guidance for all procedures but 52% never used this and 43% only in certain cases.
30% acknowledged a complaint about an injection over the previous five years, most commonly related to post-injection pain flare (77%) and lack of effect (30%).
37% obtained verbal consent and a further 37% obtained written consent, with 20% using a standardised form.
93% advised patients of the indication & anticipated benefits of injection; 86% warned of possible pain and lack of effect; 54% warned of skin changes; 20% advised of facial flushing.
38% documented at least three items in the notes (indication, name of drug and dose); 11% recorded no information and 16% were considering changing their practice in this respect.

Conclusions

Whilst the majority of respondents gave patients verbal information about injection procedures, only 37% obtained written consent and 11% made no written record. This is concerning given that 30% of respondents had received a procedure-related complaint. However 16% were considering changing their practice. In our unit we plan to pilot a standardised consent form to improve documentation of these procedures.