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Promoting informed consent in a children's hospital in Tabriz, Iran: a best practice implementation project
Neda Kabiri1,2, Sakineh Hajebrahimi2,3, Gisoo Alizadeh1
1Iranian Center of Excellence in Health Management, School of Management and Medical Information, Tabriz University of Medical Sciences, Tabriz, Iran.
Insights
Implementing best practices for informed consent in pediatric care significantly improved compliance rates. This study highlights effective strategies for enhancing patient rights and decision-making in children
Area of Science:
- Pediatric Healthcare
- Clinical Practice Improvement
- Informed Consent
Background:
- Informed consent is a critical, ongoing process in healthcare.
- Pediatric practice presents unique challenges for informed consent due to parental decision-making.
- Evaluating and enhancing informed consent practices are essential for patient rights.
Purpose of the Study:
- To assess current informed consent procedures in a pediatric hospital.
- To implement evidence-based best practices for obtaining informed consent.
- To evaluate the impact of implemented strategies on informed consent compliance.
Main Methods:
- A clinical audit using the JBI Practical Application of Clinical Evidence System (JBI PACES) tool.
- Baseline and follow-up audits assessed compliance with five best-practice criteria for informed consent.
- Interventions included departmental meetings and encouraging reporting of non-compliance.
Main Results:
- Overall compliance with informed consent criteria improved post-implementation.
- Highest compliance (97%) was achieved for obtaining consent before nursing procedures and informing about treatment necessity.
- Compliance for informing about treatment nature/effects reached 74%, and for alternatives/refusal consequences, it was 57%.
Conclusions:
- The audit demonstrated a measurable improvement in obtaining informed consent in pediatric departments.
- Implemented interventions successfully facilitated the integration of evidence-based practices into clinical workflows.
- This study supports the effectiveness of audit and feedback strategies for enhancing informed consent.
Introduction:
Informed consent is a continuous and dynamic process. It is a crucial part of healthcare procedures that becomes more complex in a pediatric clinical practice, where parents must make decisions for their children.
Objectives:
The aim of this implementation project was to evaluate the current practice and implement the best practice related to obtaining informed consent in a children's hospital in Tabriz, Iran.
Methods:
A clinical audit was undertaken using the JBI Practical Application of Clinical Evidence System (JBI PACES) tool. Five audit criteria representing the best-practice recommendations for informed consent were used. A baseline audit was conducted, followed by the implementation of multiple strategies. The project was finalized with a follow-up audit to determine change in practice.
Results:
The compliance rate of all criteria improved from baseline to follow-up audit. Criteria 1 (obtaining informed consent prior to all nursing procedures) and 5 (provision of information related to the necessity of the treatment) reached 97% compliance in the follow-up cycle. Criterion 4 (provision of information related to the nature and effect of the treatment) achieved 74% compliance. Both criteria 2 and 3 (provision of information related to alternative treatments and consequences of refusing treatment) reached 57% in the follow-up cycle. To improve compliance, meetings were organized with the heads of departments, nurses and residents regarding informed consent. Also, staff were encouraged to report cases where informed consent was not obtained.
Conclusion:
The audit results indicated an improvement in obtaining informed consent in the included departments. The interventions that were employed can facilitate the implementation of evidence into clinical practice.