CONSENT and UNIVERSAL
PRECAUTIONS
Dr Umer Ullah
Oral Medicine
• CONSENT is the expressed or implied agreement of
the patient to undergo an examination, investigation
or a treatment
• INFORMED CONSENT
– Patient must be fully aware of the procedure
– Its intended benefits
– Possible risks and complications
CONCEPT
• Patient’s right to consider known risks and benefits of a
treatment
• Voluntary decision to proceed with the recommended
treatment or choose another option
• If a complication occurs the practitioner is not legally liable in
the absence of negligence
• Patient has the right to refuse treatment even if it adversely
affects their health
CLINICIAN’S BENIFITS
1. Better rapport with the patient
2. Realistic expectations of the informed patients
3. Documented informed consent prevents frivolous
claims
4. Legal issues
Who can give a consent ?
• No one can make a decision on behalf of a competent
adult
• In emergency a life saving procedure can be performed
without a consent
• All actions must however be justifiable
• No one can give or withhold consent on behalf of a
mentally incapacitated patient ( practitioner VS court)
• CHILDREN :
– Parents
– Adoptive parents
– Local authority
PHASES OF CONSENT
1. Informing
2. Written consent
3. Documentation
INFORMATION/ DISCUSSION
1. The specific problem
2. The proposed treatment
3. Anticipated or common side effects
4. Possible complications and their frequency
5. Anesthesia
6. Treatment alternatives
7. Uncertainties about the final outcome
• OTHER ISSUES:
– Timing of appointment
– Medication
– Transport
– Duration of procedure
– Recovery period
– Post operative care
– Follow up
– Return to full activity
WRITTEN CONSENT
• Signed written informed consent form
• Summary of the information presented in layman
terms
• Patient's language should be used
• Signature:
– Patient
– Practitioner
– At least one witness
DOCUMENTATION
• Maintenance of records
• Good documentation and record keeping prevents
future dispute and litigation
SPECIAL SITUATIONS
1. Patients asks specifically not be informed
2. Therapeutic privilege ( controversial)
3. Emergency
• All the questions should be answered honestly
• Information should not be withheld
• The person obtaining consent must have sufficient
knowledge about the treatment plan
• Consent is not an isolated event
REQUIREMENTS Of CONSENT
• CAPACITY:
– Not impaired for any reason
– May differ procedure to procedure
– Understands information given
– Able to weigh information to make a decision
• VOLUNTARY:
– Given freely
– Without pressure or influence
• INFORMED:
– Understands nature and purpose of procedure
– Aware of the operators training and competence
– No information withheld
– Informed of alternative to the proposed treatment
– Aware of the risks of not having the treatment
– Aware of how any tissue removed will be treated
and stored
• CLINICIAN:
– Informed and trained
– Able to judge capacity
• TIMING:
– Consent is a process. Must be checked and
revisited
– Consent remains in force until withdrawn
– Consent should be within a reasonable timeframe
of the procedure
• RECORDED:
– The process must be recorded
– Written consent is required for more significant
procedures and risk
UNIVERSAL
PRECAUTIONS
LIMITING SPREAD of HEPATITIS
• FROM INFECTED PATIENTS TO OTHER PATIENTS:
– Use of disposable materials
– Disinfection of surfaces ( via iodophors,
hypochlorite, glutaraldehyde etc)
– Sterilization of reusable instruments
• FROM INFECTED PATIENTS TO DENTAL STAFF:
– Recognize individuals likely to be carriers
– Use of barrier techniques ( gloves, mask etc)
during surgery, handling of contaminated objects
and cleanup.
– Disposal of sharp objects in labeled protective
containers
– Dispose of needles or re-sheathing
– Vaccination of staff
UNIVERSAL PRECAUTIONS
1. Doctors and staff coming in contact with blood or
secretions of patients must use barrier techniques
• Facemask
• Gloves
• Eye protection
• Hair coverage
1. Decontamination or disposing of all surfaces that
get exposed to patient blood, tissue and secretions
2. Avoidance of touching surfaces e.g. dental record,
computer keyboard, uncovered light handle,
telephone etc with contaminated gloves or
instruments
