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Ideally, as part of shared decision making, consent for surgical and anaesthetic procedures should be obtained prior to the day of surgery (see recommendation 4.3), allowing sufficient time for the patient to reflect on their consent discussion.67 The competent patient has a fundamental right, under common law, to give, or to withhold, consent to examination, investigation and treatment.66,67,99
Where a patient is seen prior to the day of surgery and shared decision making and discussion of anaesthetic conduct has taken place, the anaesthetist on the day of surgery has a responsibility to ensure the patient still understands and agrees with the perioperative plan.66,67
The patient must be made aware of alternative treatment options, or the option for no treatment at all. It is acceptable to recommend one of the alternatives but as the GMC states ‘The doctor may recommend a particular option which they believe to be best for the patient, but may not put any pressure onto the patient to accept their...
No other person can consent to treatment on behalf of any adult. If a health and welfare lasting power of attorney directive is in place, the attorney may be able to assent to treatment on behalf of the patient. There should be a local process and policy in place for patients who lack capacity that conforms to national guidance and...
Perioperative time should be allocated for the work the anaesthetist undertakes on the day of procedure for both pre and postoperative care. The time required for pre and postoperative care will vary and should be accounted for in individual job plans.
Anaesthesia departments should have a nominated anaesthetist immediately available (see Glossary) and free from direct clinical responsibilities to provide cover in clinical emergencies, as well as providing advice and support to other anaesthetists.41
Anaesthesia departments should make arrangements to allow anaesthetists working solo during long surgical procedures or on overrunning lists to be relieved by a colleague or AA for meal and comfort breaks.116,117,112
Anaesthesia associates should work within the scope of practice and levels of supervision defined by the RCoA188.
AAs should always work within an anaesthesia team led by a consultant or other autonomously practising anaesthetist who has overall responsibility for the anaesthesia care provided for the patient and whose name should be recorded in the individual patient’s medical notes.119
Anaesthetists providing supervision to other anaesthetists or AA’s should be easily contactable, able to provide the level of supervision required by individual supervisees and free to attend in an appropriate timeframe.119
