Acute pain and narcotic use does not impair the ability to provide informed consent : Evaluation of a competency assessment tool in the acute pain patient

• Published in: The American surgeon Vol. 72; no. 2; pp. 154 - 157
• Main Authors: LUCHA, Paul A, KROPCHO, Luisa, SCHNEIDER, James J, FRANCIS, Michael
• Format: Journal Article
• Language: English
• Published: Atlanta, GA Southeastern Surgical Congress 01.02.2006; SAGE PUBLICATIONS, INC
• Subjects: Acute Disease; Adult; Aged; Analgesics, Opioid - pharmacology; Analysis of Variance; Biological and medical sciences; Cognition - drug effects; Effects; Female; General aspects; Humans; Informed Consent; Male; Medical sciences; Mental Competency; Middle Aged; Narcotics; Pain - drug therapy; Pain management; Pain, Postoperative - drug therapy; Psychiatric Status Rating Scales; Surgery; United States; United States; Ability; Human; Evaluation; Acute; Use; Patient; Medicine; Pain; Treatment; Surgery; Professional competence; Informed consent; Tool
• ISSN: 0003-1348; 1555-9823
• DOI: 10.1177/000313480607200212

Patients evaluated in acute pain will often have narcotics withheld until after the patient has been evaluated by a surgeon and has given informed consent. Concern that the patient would have impaired judgment due to narcotic effects often prevents the administration of timely pain relief. The Hopkins Competency Assessment Tool (HCAT) is a validated instrument for both psychiatric and medical patients; it has not been validated to evaluate drug effects on judgment. Thirty consecutive patients agreed to participate in the trial over a 12-month period. The HCAT was administered prior to the planned major elective procedure and repeated on each postoperative day up to and including postoperative day 5. Narcotic use (as morphine equivalents), HCAT scores, demographic data, and surgical procedures were recorded. The average age of our patients was 53 years. Twenty-seven patients passed the initial HCAT, and one patient failed subsequent exams. No correlation was seen between HCAT score and narcotic dose. Narcotic administration sufficient for pain control does not impair the ability to provide informed consent. The only patient who failed the HCAT after an initial passing score was somnolent on the narcotic dose.