20-year-old lady for Removal of wisdom teeth

Previous cancellation on day of surgery as declining OT

Background:

• Ex-premature baby; 25 weeks
• Mild developmental delay
• Autism

Issues:

• Attended hospital on day of surgery with her father, declining OT, and premedication
• Previous traumatic experiences in theatre as a child, felt she was having medical procedures against her wishes.
• Patient stated she doesn’t have any dental pain, doesn’t need or want to have teeth extracted
• Father had signed consent form but is not official enduring guardian
• Procedure was cancelled on DOS in accordance with the patient’s wishes 

Discussion

• Formal assessment of capacity:
  • NSW health special disability referral team pathway
  • Temporary guardianship order granted. 
  • Lengthy process
• Father struggling with this issue and prefers not to become guardian in this instance

• No psychological or social support for those with PTSD to mitigate stressors of attending hospital/OT as there are for children.
• Consensus that even if patient doesn’t have legal capacity, it will be very difficult to carry out minor (non-life or limb-threatening procedures) if patient not willing.
• Premedication unlikely to improve situation as previously declined

Plan

• Consider pre-hospital premedication
• Preoperative psychology input
• Liaise with procedural anaesthetist