Informed consent for peripheral nerve blocks at a tertiary level hospital in South Africa: a quality improvement project

Simple item page
dc.contributor.advisorGibbs, Matthew
dc.contributor.advisorPlenge, Ulla
dc.contributor.authorBurger, Roxanne
dc.date.accessioned2025-11-14T09:02:55Z
dc.date.available2025-11-14T09:02:55Z
dc.date.issued2025
dc.date.updated2025-11-14T06:41:28Z
dc.description.abstractBackground: In South Africa, the doctrine of informed consent (introduced by the South African courts, Cape Provincial Division) dictates that all reasonable patients be told of material risks and alternative options before consenting to medical treatment or procedural interventions. The reasonable patient standard requires that a patient be told of all material risks that would influence a reasonable person in determining whether or not to consent to the treatment. Regional anaesthesia, including peripheral nerve blocks (PNBs), provides a plethora of benefits to patients undergoing surgery but, due to potential risks involved, also requires informed consent. Studies have shown that South African anaesthetists do not regularly obtain adequate informed consent for these procedures. We implemented a quality improvement project to facilitate and enhance documented informed consent in our setting. Methods: A prospective quality improvement project was established at Groote Schuur Hospital, Cape Town, including all PNBs performed in two-week blocks before and after the introduction of a standardised regional anaesthesia informed consent form. The primary outcome, comparing the incidence of documented informed consent between the two groups, was assessed with the McNemar paired-sample test for differences in proportions. Regression analysis was used to explore the effect of prespecified confounders (such as documented consent taken, benefits discussed, alternatives discussed, complications discussed and whether autonomy was documented). Results: In total, 39 and 43 patients were included in the pre- and post-intervention groups, respectively. In our setting, anaesthetists were 4.16 times (95% confidence interval (CI) -6.67 to -2.98, p < 0.001) more likely to take documented informed consent when provided with a standardised form. The incidence of documented informed consent improved from 7.7% to 60.5%. Regression analysis showed that these confounders influenced the recall of the PNB consent and discussed benefits and complications. Overall, recall was mostly influenced when benefits were discussed with patients (95%CI -20.023 to -14.64, p < 0.001). Conclusion: Documentation of informed consent for PNBs in our setting is poor. A standardised consent form can facilitate the documentation of consent significantly. Patient recollection of the consent process also improved, specifically when benefits were discussed.
dc.identifier.apacitationBurger, R. (2025). <i>Informed consent for peripheral nerve blocks at a tertiary level hospital in South Africa: a quality improvement project</i>. (). ,Faculty of Health Sciences ,Department of Anaesthesia and Perioperative Medicine. Retrieved from http://hdl.handle.net/11427/42222en_ZA
dc.identifier.chicagocitationBurger, Roxanne. <i>"Informed consent for peripheral nerve blocks at a tertiary level hospital in South Africa: a quality improvement project."</i> ., ,Faculty of Health Sciences ,Department of Anaesthesia and Perioperative Medicine, 2025. http://hdl.handle.net/11427/42222en_ZA
dc.identifier.citationBurger, R. 2025. Informed consent for peripheral nerve blocks at a tertiary level hospital in South Africa: a quality improvement project. . ,Faculty of Health Sciences ,Department of Anaesthesia and Perioperative Medicine. http://hdl.handle.net/11427/42222en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Burger, Roxanne AB - Background: In South Africa, the doctrine of informed consent (introduced by the South African courts, Cape Provincial Division) dictates that all reasonable patients be told of material risks and alternative options before consenting to medical treatment or procedural interventions. The reasonable patient standard requires that a patient be told of all material risks that would influence a reasonable person in determining whether or not to consent to the treatment. Regional anaesthesia, including peripheral nerve blocks (PNBs), provides a plethora of benefits to patients undergoing surgery but, due to potential risks involved, also requires informed consent. Studies have shown that South African anaesthetists do not regularly obtain adequate informed consent for these procedures. We implemented a quality improvement project to facilitate and enhance documented informed consent in our setting. Methods: A prospective quality improvement project was established at Groote Schuur Hospital, Cape Town, including all PNBs performed in two-week blocks before and after the introduction of a standardised regional anaesthesia informed consent form. The primary outcome, comparing the incidence of documented informed consent between the two groups, was assessed with the McNemar paired-sample test for differences in proportions. Regression analysis was used to explore the effect of prespecified confounders (such as documented consent taken, benefits discussed, alternatives discussed, complications discussed and whether autonomy was documented). Results: In total, 39 and 43 patients were included in the pre- and post-intervention groups, respectively. In our setting, anaesthetists were 4.16 times (95% confidence interval (CI) -6.67 to -2.98, p < 0.001) more likely to take documented informed consent when provided with a standardised form. The incidence of documented informed consent improved from 7.7% to 60.5%. Regression analysis showed that these confounders influenced the recall of the PNB consent and discussed benefits and complications. Overall, recall was mostly influenced when benefits were discussed with patients (95%CI -20.023 to -14.64, p < 0.001). Conclusion: Documentation of informed consent for PNBs in our setting is poor. A standardised consent form can facilitate the documentation of consent significantly. Patient recollection of the consent process also improved, specifically when benefits were discussed. DA - 2025 DB - OpenUCT DP - University of Cape Town KW - South Africa KW - Hospital KW - Informed consent KW - Documentation KW - Peripheral nerve blocks LK - https://open.uct.ac.za PY - 2025 T1 - Informed consent for peripheral nerve blocks at a tertiary level hospital in South Africa: a quality improvement project TI - Informed consent for peripheral nerve blocks at a tertiary level hospital in South Africa: a quality improvement project UR - http://hdl.handle.net/11427/42222 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/42222
dc.identifier.vancouvercitationBurger R. Informed consent for peripheral nerve blocks at a tertiary level hospital in South Africa: a quality improvement project. []. ,Faculty of Health Sciences ,Department of Anaesthesia and Perioperative Medicine, 2025 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/42222en_ZA
dc.language.rfc3066eng
dc.publisher.departmentDepartment of Anaesthesia and Perioperative Medicine
dc.publisher.facultyFaculty of Health Sciences
dc.subjectSouth Africa
dc.subjectHospital
dc.subjectInformed consent
dc.subjectDocumentation
dc.subjectPeripheral nerve blocks
dc.titleInformed consent for peripheral nerve blocks at a tertiary level hospital in South Africa: a quality improvement project
dc.typeThesis / Dissertation
dc.type.qualificationlevelMasters
dc.type.qualificationlevelMMed
Files
Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
thesis_hsf_2025_burger roxanne.pdf
Size:
1.48 MB
Format:
Adobe Portable Document Format
Description:
Download
License bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
license.txt
Size:
1.72 KB
Format:
Item-specific license agreed upon to submission
Description:
Download
Collections
Masters