Consent, tonsillectomy

CONSENT INFORMATION – PATIENT COPY

TONSILLECTOMY

PLEASE READ THIS SHEET BEFORE YOU CONSENT FOR YOUR PROCEDURE

This information sheet provides general information to a person having a Tonsillectomy. It does not provide advice to the individual. It is important that the content is discussed between the patient and the concerned doctors who understand the level of fitness and medical condition.

What are the “Tonsils”?

The tonsils are two oval lumps of tissue. They sit on either side of the back of your throat behind your tongue. The tonsils are involved in helping your body fight infection but they are not essential to your health.

What is “Tonsillectomy”?

A tonsillectomy is an operation to remove the tonsils. The operation may be necessary for people who get repeated or very severe bouts of tonsillitis that interfere with normal life.

Why have a tonsillectomy?

Sometimes the tonsils can become infected, either with a virus or with bacteria, causing symptoms such as a sore throat, painful swallowing, headache and fever. This is called tonsillitis.

The majority of people who get tonsillitis do not need an operation. Your surgeon will usually only suggest it for people who have had:
* at least five bouts of tonsillitis in the past year
* frequent ear infections because of swollen tonsils
* swollen tonsils that make it harder to breathe or swallow
* sore throats that stop you, or your child, getting on with everyday life (such as finding it hard to sleep or your child missing school)

What are the alternatives?

Many children "grow out" of tonsillitis over a year or so and do not need any treatment at all. There are treatments for tonsillitis that don't involve surgery, such as painkillers to help reduce discomfort. Antibiotics are the only other treatment that is used to try to treat sore throats in the long-term.

Sometimes, a long-term course of antibiotics is prescribed to try and avoid the need for a tonsillectomy. Tonsillitis that is caused by bacteria often responds well to this treatment. However, the most common type of tonsillitis is caused by a virus, and cannot be treated in this way.
Your doctor will discuss the available options with you.

 What happens before tonsillectomy?

Your surgeon will discuss how to prepare for the operation.
It is unlikely that your surgeon will perform a tonsillectomy if a person has an infection. This is because an infection can increase the chance of chest problems. You should advise the hospital if you, or your child, has a sore throat or cold in the week before the operation date as it may need to be postponed.

What to expect in hospital

Before surgery you will talk to your surgeon about the operation and you will be asked to sign a Consent Form either for yourself, or on behalf of your child. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.
Fasting instructions must be followed before a general anesthetic. Typically, you must not eat or drink for about six hours. However, some anesthetists allow occasional sips of water until two hours beforehand.

The operation

The tonsillectomy is often performed under a general anesthesia, which means that people are asleep throughout the procedure and feel no pain.
A tonsillectomy generally takes about half an hour and an overnight stay in hospital is usually necessary.
Once the anesthesia has taken effect, your mouth is held open so that the surgeon can see into your throat. No cuts are made in the skin.
There are a number of different methods that your surgeon can use to remove the tonsils.
* The tonsils can be cut away with special scissors. Dissolvable stitches are then used to close the wound and to stop the bleeding.
* Lasers, ultrasound and freezing can also be used to take out tonsils. They are newer methods and aren't commonly used.
* Diathermy - an instrument that heats to a temperature of about 100°C can also be used. The heated instrument cuts away the tonsils and seals up the area where they have been removed from.
* Coblation (or cold ablation) uses a lower temperature (about 60°C) to cut away the tonsils.

After the operation

As the anesthesia wears off, the throat or ears, or both, will feel sore and the jaw may be stiff. Painkillers will be given to help relieve any discomfort.
After about 12 hours, a white or yellowish membrane (thin skin) will appear where the tonsils were. This is nothing to worry about and is not a sign of infection. It's just new skin growing over the wound.
People are encouraged to begin to drink and eat as soon as they feel ready, starting with clear fluids such as water or apple juice.
Most patients stay in hospital for one night. In some hospitals tonsil surgery is done as a day-case, which means you can have the operation and go home the same day. Either way, the hospital will only let a patient go home when he or she is eating and drinking and feeling well enough to go home.
However, due to the general anesthetic, you will need to arrange for a friend or relative to drive you home and stay with you for the next 24 hours.

 Recovering from a tonsillectomy

Once home, more painkillers can be taken if needed, as advised by your surgeon or nurse.
Eating will be difficult to start with, and soft or liquid foods will be less uncomfortable. Although it may be painful, swallowing solid food like toast and cereal will help healing by scraping away dead tissue. Taking a dose of painkillers half an hour before meals may help to ease any discomfort.
The teeth may be brushed as normal.
It is advisable to stay at home for 7-14 days after the operation, avoiding (where possible) contact with people who have colds, coughs or other infections. Strenuous activities should also be avoided during this time.
Complete recovery can take two weeks.

General Risks of having the procedure:

These have been mentioned in the “Anesthesia Consent Form.” Please discuss this with your Anesthetist before signing the Anesthesia Consent Form.

What are the risks of the procedure?

While majority of patients have an uneventful procedure and recovery, few cases may be associated with complications. These are seen infrequently and not all the ones listed below are applicable to one individual. However it is important that you are aware of the complications/risks that may arise out of this procedure which are as below:
There are some risks/ complications, which include:
(a) Bleeding. This may either at the time of surgery or in the first 2 weeks after surgery. Delayed bleeding may require readmission to hospital and may require another operation to stop the bleeding. A blood transfusion may be necessary depending on the amount of blood lost.
(b) Burns from the equipment used to seal off bleeding areas during the operation.
(c) Infection. Persistent bad breath, worsening throat discomfort or delayed bleeding may indicate an infection. This is usually treated with antibiotics. Delayed bleeding is treated as outlined above.
(d) Pain. Moderate throat pain is common during the first 2 weeks after surgery, requiring regular analgesia. Rarely, pain in the area back of the tongue or back of the throat.
(e) Injury to the teeth, lips, gums or tongue. There can also be a temporary change in sensation to tongue.
(f) Abnormal scarring may rarely occur causing narrowing or stenosis of the throat or strange sensations in the throat.
10. Consent Acknowledgement:
* The doctor has explained my medical condition and the proposed surgical procedure.
* I understand the risks of the procedure, including the risks that are specific to me, and the likely outcomes. The doctor has explained other relevant treatment options and their associated risks, the prognosis and the risks of not having the procedure.
* I have been given an Anesthesia Informed Consent Form.
* I have been given a Patient Information Sheet about the Condition, the Procedure, and associated risks.
* I was able to ask questions and raise concerns with the doctor about my condition, the procedure and its risks, and my treatment options.
* My questions and concerns have been discussed and answered to my satisfaction.
* I understand that the procedure may include a blood / blood product transfusion.
* I understand that if organs or tissues are removed during the surgery, that these may be retained for tests for a period of time and then disposed of sensitively by the hospital.
* The doctor has explained to me that if immediate life-threatening events happen during the procedure, they will be treated as appropriate.
* It has been explained to me, that during the course of or subsequent to the Operation/Procedure, unforeseen conditions may be revealed or encountered which may necessitate urgent surgical or other procedures in addition to or different from those contemplated. In such exigency, I further request and authorize the above named Physician / Surgeon or his designee to perform such additional surgical or other procedures as he or they consider necessary or desirable.

On the basis of the above statements,
I REQUEST TO HAVE THE PROCEDURE.
Name of Patient/Substitute Decision Maker…………………………………………….
Relationship …………………………………….
Signature………………………………………
Date………………………………………………

Name of the Witness…………………………
Relationship/Designation………………………
Signature………………………………………..
Date……………………………

INFORMED CONSENT: TONSILLECTOMY


Patient Identification Label to be affixed here






A. INTERPRETER
An interpreter service is required.Yes______________No_______________
If Yes, is a qualified interpreter present.Yes_____________No___________

B. CONDITION AND PROCEDURE
The doctor has explained that I have the following condition:
(Doctor to document in patient’s own words)
_______________________________________________and I have been advised to undergo the following treatment/procedure____________________________________________________________________________________________________________________________________________________________
See patient information sheet- "Tonsillectomy” for more
C.ANAESTHETIC
Please see your “Anesthesia Consent Form”. This gives you information of the General Risks of Surgery. If you have any concern, talk these over with your anesthetist.

D.RISKS OF THIS PROCEDURE
While majority of patients have an uneventful surgery/procedure and recovery, few cases may be associated with complications. These are seen infrequently and not all the ones listed below are applicable to one individual. However it is important that you are aware of the complications/risks that may arise out of this procedure which are as below:

There are some risks/ complications, which include:
(a) Bleeding. This may either at the time of surgery or in the first 2 weeks after surgery. Delayed bleeding may require readmission to hospital and may require another operation to stop the bleeding. A blood transfusion may be necessary depending on the amount of blood lost.
(b) Burns from the equipment used to seal off bleeding areas during the operation.
(c) Infection. Persistent bad breath, worsening throat discomfort or delayed bleeding may indicate an infection. This is usually treated with antibiotics. Delayed bleeding is treated as outlined above.
(d) Pain. Moderate throat pain is common during the first 2 weeks after surgery, requiring regular analgesia. Rarely, pain in the area back of the tongue or back of the throat.
(e) Injury to the teeth, lips, gums or tongue. There can also be a temporary change in sensation to tongue.
(f) Abnormal scarring may rarely occur causing narrowing or stenosis of the throat or strange sensations in the throat.

SIGNIFICANT RISKS AND RELEVANT TREATMENT OPTIONS:F. SIGNIFICANT RISKS AND
The doctor has explained any significant risks and problems specific to me, and the likely outcomes if complications occur.
The doctor has also explained relevant treatment options as well as the risks of not having the procedure.
(Doctor to document in Medical Record if necessary. Cross out if not applicable. )

PATIENT CONSENT: CONSENT
I acknowledge that:
* The doctor has explained my medical condition and the proposed procedure. I understand the risks of the procedure, including the risks that are specific to me, and the likely outcomes.
* The doctor has explained other relevant treatment options and their associated risks. The doctor has explained my prognosis and the risks of not having the procedure.
* I have been given a Patient Information Sheet on Anesthesia.
* I have been given the patient information sheet regarding the condition, procedure, risks and other associated information.
* I was able to ask questions and raise concerns with the doctor about my condition, the procedure and its risks, and my treatment options. My questions and concerns have been discussed and answered to my satisfaction.
* I understand that the procedure may include a blood transfusion.
* I understand that if organs or tissues are removed during the surgery, that these may be retained for tests for a period of time and then disposed of sensitively by the hospital.
* The doctor has explained to me that if immediate life-threatening events happen during the procedure, they will be treated accordingly.
* I understand that photographs or video footage maybe taken during my operation. These may then be used for teaching health professionals. (You will not be identified in any photo or video).
* I understand that no guarantee has been made that the procedure will improve the condition, and that the procedure may make my condition worse.

On the basis of the above statements,
I hereby authorize Dr……………………………………………………………………and those he may designate as associates or assistants to perform upon me the following medical treatment, surgical operation and / or diagnostic / therapeutic procedure…………………………………………………………..

I REQUEST TO HAVE THE PROCEDURE

Name of Patient/Substitute Decision Maker…………………………………………….
Relationship …………………………………………………………………………………….
Signature……………………………………………Date……………………………………….

Name of the Witness…………………………………………………………………………
Relationship/Designation………………………………………………………………………
Signature……………………………………………Date………………………………………
FERENCES
INTERPRETER’S STATEMENT:
I have given a translation in……………………………………………………………………
Name of interpreter…………………………………………………………………………….
Signature……………………………………………Date………………………………………

DOCTOR’S STATEMENTS
I have explained
* The patient ‘s condition
* Need for treatment
* The procedure and the risks
* Relevant treatment options and their risks
* Likely consequences if those risks occur
* The significant risks and problems specific to this patient

I have given the Patient/ Guardian an opportunity to:
* Ask questions about any of the above matters
* Raise any other concerns, which I have answered as fully as possible.

I am of the opinion that the Patient/ Substitute Decision Maker understood the above information.

Name of doctor…………………………………………………………………………..
Designation………………………………………………………………………………
Signature………………………………………Date……………………………………