Informed consent: is it really understood?

Pre-operative counselling is an important part of the care that we give to our patients undergoing surgery. It ensures that the patients understand about their disease and the procedure that they are undergoing. This study was done with the objective of finding whether or not the patients do actually understand what has been explained to them. This is a prospective study done in the form of a survey with a set questionnaire in two hospitals in Kathmandu namely Patan hospital and Tribhuvan University Teaching Hospital. The patients surveyed were those who were admitted for elective surgery after counselling has been done and consent forms signed. The result showed that the level of understanding was poor in 11%, unsatisfactory in 33%, satisfactory in 37% and excellent in 19%. The level of understanding was affected by the education level of the patients. To conclude, the level of understanding was unsatisfactory in nearly half the patients. Only 19% had optimal understanding. This may reflect the education level of the many of our patients but it clearly points out that the medical profession needs to make more effort to make the patients understand more about their disease process. This can be said to be a reflection of our quality of care.

How safe is transfusion of uncross-matched group-specific blood?

OBJECTIVE: Uncross-matched blood either group specific or Group O is advocated in patients with exsanguinating haemorrhage when cross-matched blood cannot be made available rapidly. The risk of using uncross-matched blood is not known clearly. The purpose of this study is to attempt to quantify the risk of major transfusion reactions resulting from the use of uncross-matched group specific blood. METHOD: The cross-matching record of Patan hospital for the period of two years was analysed looking at the number of units that had major or minor incompatibility among all the cross-matching done during this period. RESULT: A total of 6027 units were cross-matched in two years. Only one unit of blood was found to have both major and minor incompatibility. All other units of blood taken out from the freeze for the purpose of cross-matching matched the patients blood. This puts the risk of having major transfusion reaction from incompatible blood when using uncross-matched group-specific blood at 1 in 6000. CONCLUSION: Using uncross-matched group specific blood in patients with severe haemorrhage, when delay in transfusion can put life at risk, is justifiable and needs to be encouraged.