Knowledge of confidentiality, consent and information disclosure is not affected by position or experience in adult critical care

Abstract

Introduction Teaching of medical ethical issues including conf den-tia lity and consent have long been a small part of the medical curriculum. These issues are more complex in an ICU where patients may lack capacity. Documents such as Good Medical Practice 1995, Conf dentiality 2009 and the Mental Capacity Act 2005 give guidance to medical professionals in these matters in the UK. Methods A questionnaire was distributed amongst staf in four ICUs in South London. Results were analysed according to level of experience and background (medical/nursing or allied health professional (AHP)). Results Of 225 questionnaires distributed, the response rate was 66% (31% doctors, 56% nurses and 13% AHP). Staf with either less than 1 year experience or greater than 10 years experience had the greatest exposure to the Mental Capacity Act and Data Protection Act, suggesting a gap in knowledge in staf with intermediate experience. Knowledge of the Caldicott principles were unaf ected by experience, with many experienced respondents having 'No Idea'. The majority of respondents (unaf ected by experience) felt that when giving information to relatives face to face, relatives should be kept fully informed. When giving information over the telephone, most doctors felt the response should be tailored to the knowledge of the person being spoken to whilst nurses were split between tailoring the response, giving full information, setting up a password system and not giving any information at all. Most respondents felt date of birth and hospital number constituted 'Patient Identif able Information'. However, experienced staf did not appreciate the importance of unusual diagnosis and clinical photographs as also being able to identify patients. Similarly, the majority knew that the patient themselves identif ed the 'Next of Kin' but 7% (unaf ected by experience) felt this was decided by the family and felt the family could decide on resuscitation status. When consent is required for an elective procedure in a patient who lacks capacity, doctors tended to have a better understanding of the need to delay the procedure where possible than nurses, the majority of which felt this could be decided by the next of kin or two consultant doctors. Most doctors felt that 'Acting in the Patient's Best Interests' would mean doing what would give the patient the best outcome rather than doing what the patient would have wanted (unaf ected by experience). The majority of staf , on answering this questionnaire, felt that they lacked suf cient knowledge on the subject and most felt annual reminders would be useful. Conclusion The ICU is an environment where issues of consent, conf dentiality and disclosure of information occur daily. Staf feel they lack knowledge in these areas that is unaf ected by their experience. We need to ensure that all staf have the necessary knowledge to deal with these situations.