Preop summary and consent

From 9.15.0 a hospital can add two documents to the preoperative assessment:

• a preop summary page, between the preoperative and intraoperative records; and
• a written consent for anaesthesia, printed with the summary.

Both are off until an administrator switches them on, on the preoperative form page in Status. The consent needs the summary: switching the summary off switches the consent off too.

What clinicians see

With the summary on, a clinician who finishes the preop assessment reaches the summary page. From there they:

• keep the case or hand it over;
• print the summary, and the consent when it is on; then
• start the intraoperative record.

A phone that is offline reads both switches as off, so its flow stays preop to intraop and works without a connection. See Protocol & Printing for what prints.

The patient or parent signs the consent on paper. Patient names and ID numbers are never stored: the sheets print blank lines for them.

Print layout

The administrator picks one of five layouts. B is the default.

Layout	What prints
A · Document №2, filled in	The ward's paper form in its own order, sections I to V, with every answer LOSPOR holds printed in and the rest left for the pen. The consent follows in full.
B · Summary, then consent	A summary for the colleague taking the case over, with the whole questionnaire, then the whole consent in two columns.
C · Consent per technique	Before printing, the anaesthetist ticks the planned techniques. The consent describes only those, and general anaesthesia as the fallback, each with a box for the patient's initials. Needs the technique tags in the text.
D · One sheet, both sides	A dense summary on the front and the consent as a table on the back, one row per technique, word for word. Needs a double-sided printer and the technique tags in the text.
E · Hospital copy and patient's copy	The hospital's pages carry the summary and the signatures. A large-print page with the fasting instructions, and the full consent text, go home with the patient or parent.

Consent texts

There are two texts, each with its own versions:

• Adults and patients of 14 to 18; and
• Children under 14.

Each starts as a bundled Bulgarian text. Each save makes a new version:

• Fingerprint: a printed sheet records the version and fingerprint of its text, so earlier versions are never deleted. The database refuses any change to a saved version.
• Identical words: saving the same words again makes no new version.
• Audit: every save needs the administrator password and a reason, and is audited.

Under Закон за здравето чл. 89, consent to general anaesthesia is given in writing. The text should name the anaesthesia, its risks and its alternatives (чл. 88).

How to write the text

• Paragraphs: a blank line starts a new paragraph.
• Headings: ## at the start of a line makes a heading.
• Lists: - at the start of a line makes a list item.
• Bold: **…** makes words bold.
• Case fields: filled in from the case when the sheet prints: {{hospital}}, {{diagnosis}}, {{procedure}}, {{date}} and {{anaesthetist}}. Any other {{…}} is refused.
• Technique tags (layouts C and D): end the heading of each technique with its tag, for example ## Обща анестезия [general]. The tag never prints, and an unknown tag is refused. The tags are:
  • [general] general anaesthesia;
  • [neuraxial] spinal, epidural or caudal;
  • [block] peripheral nerve block;
  • [sedation] sedation or premedication;
  • [combined] combined anaesthesia;
  • [cvc] central venous line;
  • [arterial] arterial line;
  • [ventilation] ventilation after the operation.
• Fasting: the list under ## Гладуване prints the nil-by-mouth hours assigned to the child at the preop visit, when there are any. Otherwise it prints as written.
• Fixed parts: the patient's name, ID and the signature lines are fixed parts of the sheet, not of the text. Who signs follows the age (чл. 87):
  • a parent under 14;
  • the patient and a parent from 14 to 18;
  • the patient from 18;
  • the anaesthetist always.

Research

Each consent print is recorded on the case with the text's version and fingerprint, the layout and, for layout C, the techniques it described. A finalised case takes no new print record. The cloud demonstrations have no editor for these settings.