20-year-old lady for Removal of wisdom teeth
Previous cancellation on day of surgery as declining OT
- Ex-premature baby; 25 weeks
- Mild developmental delay
- 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
- 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
- Consider pre-hospital premedication
- Preoperative psychology input
- Liaise with procedural anaesthetist