Guidelines for Consent in Newborn Care
This Guideline is currently under review
|National and ADHB Guidelines||Written or Signed Consent||Verbal Consent||Procedures|
‘Services may be provided to a consumer only if that consumer (the parent or guardian on NICU) makes an informed choice and gives informed consent (Right 7.1).’
‘Where a consumer is not competent … and no person entitled to consent on behalf of the consumer is available, the provider may provide services where (a) it is in the best interest of the consumer; and (b) reasonable steps have been taken to ascertain the views of the consumer; and (c) either, - (i) If the consumer’s views have been ascertained, … that the provider believes that the provision of services in consistent with (those views); or (ii) if the consumer’s views have not been ascertained, the views of other persons who are interested in the welfare of the consumer are taken into account. (Right 7.4)’
Right 4 states that every consumer has the right to have services provided with reasonable care and skill. The services must comply with legal, professional, ethical, and other relevant standards. They must be provided in a manner consistent with his or her needs. They must be provided in a manner that minimises the potential harm to, and optimises the quality of life of, that consumer.
Neonatal intensive care often involves a prolonged stay with the parents not present for much of the time. However, we encourage parents to be involved in both the care of their baby and the decisions on treatment.
Parents must be informed of the condition of their infant and the treatment that is to be/being used. Such information sharing is usually considered to be adequate consent for ongoing intensive care.
If possible, parents should be seen before delivery and likely treatment explained. This is usually only possible for parents of some very low birth weight infants.
At delivery, the baby’s condition and the initial treatment that is necessary should be explained. Often the father accompanies the baby to NICU, and can receive further explanation and information.
For ongoing problems and treatment, the parents should be informed as the baby’s condition changes and the new treatments are introduced. Ideally this can be done before the treatment. However, on some occasions this is not possible (parents may not be readily available, the treatment may be urgent or there may not be time because the unit is busy). In such situations the doctor or nurse should inform the parents as soon as is practicable.
Some treatments and investigations can be anticipated, and discussed before they occur. Examples are ultrasounds, long lines, phototherapy, treatment of PDA etc.
Discussions with parents on treatment are done by all staff. The FLNs have an important role in keeping parents informed of ongoing treatment. Written information (pamphlets and the ‘baby book’ etc) is particularly useful. Medical staff and NS-ANPs need to ensure that parents are adequately informed on the specifics for their baby.
Discussions with parents should be recorded in the clinical record. It is not practical to record every discussion with parents, but those involving significant new or changes in treatment should be.
Occasionally, parents have very little involvement in the care of their baby on NICU and are difficult to contact. The need for ongoing changes in treatment should be discussed with such parents when they are present or are in contact.
Postnatal dexamethasone should be discussed in detail and consent obtained, because of the uncertainties surrounding its use. Such discussion should be recorded in the clinical record.
Note: Urgent treatment should never be withheld or delayed until the parents have been informed. However the treatment must be discussed with the parents afterwards.
|Blood samples||Oxygen and CPAP||Phototherapy|
|Antibiotics||Ventilation||Type of feeding|
|Other drugs||X-rays||Milk used|
|IV fluids||Ultrasounds||Tube feeds|
|Umbilical lines||Vitamin K||Guthrie card|