Management of surgical patients who decline a COVID-19 diagnostic test

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This guidance is to support staff in making patient placement and clinical decisions associated with surgical patients who decline COVID 19 PCR swab testing or lack capacity and refuse to undergo a swab

The most common test for COVID-19 is nasopharyngeal swab test, though a shorter nasal swab or throat swab is acceptable.

Patients have the right to refuse a COVID-19 test. In this situation:

  • Named clinician should be informed of patient’s refusal
  • Named clinician contacts patient to enable further exploration of the reasons to decline
  • Patients should be reminded of the following:
    • Testing is in the best interests of themselves, patients and staff
    • Risks and benefits of COVID-19 testing
    • The psychological impact on staff
    • Advise shielding for 14 days
  • If the patient continues to decline testing, this should be clearly documented in patient’s clinical notes/ letter to GP

Quick Reference Guide

1.    

For patients in Surgical Prioritisation Categories P1-P3C

If pre assessment is indicated the named clinician to inform Pre-assessment team with patient’s decision

2.     

If a patient is unable to give informed consent and resists undergoing a swab test an assessment of their mental capacity must be completed and recorded in the clinical notes.

3.     

A person may lack capacity but be agreeable to a swab test, in which case it would be appropriate to proceed under best interests.

4.     

Patients whose COVID-19 status is unknown who require surgery or procedures should be placed last on the theatre list where possible.

5.     

Post operative receiving wards should be notified by administration staff with details of patients who declined COVID-19 testing prior to surgery.

6.     

Patients who do not consent, or are unable to consent to a COVID-19 test and refuse to undergo a swab, should be isolated in a single room (wherever possible) for the duration of their stay and until discharge or for 14 days, if their stay is longer. If no isolation rooms available, patients can be placed in a bay with strict adherence to 2 meter social distancing. Do not put the patient in a bay where shielded or extremely vulnerable patients may be.

7.  

Allow at least 48 hours following COVID-19 vaccine prior to surgery (whenever possible)

8.

PPE:

Patients:

  • Patients whose COVID-19 status is unknown, should be given a Fluid Resistant Face Mask (FRSM) to wear at all times, if they can tolerate it.
  • Patients should be given an information leaflet on mask use to guide its safe use, including hand hygiene, storage and disposal.

Staff:

  • PPE for staff providing direct patient care to patients whose COVID-19 status is unknown includes
    • Fluid Resistant Surgical face Mask (FRSM)
    • Disposable apron
    • Clean, non-sterile gloves
    • Eye protection (risk assess)
  •  Additional PPE for Aerosol Generating Procedures (AGP) includes:
    • Filtering face piece respirator or powered air respirator
    • Long sleeved fluid resistant gown (disposable or reusable)
    • Gloves
    • Full face visor

9.

For patients in Surgical Prioritisation Categories P3A/P4

If the patient continues to decline testing then these cases should be considered on a case by case basis by the Clinical Assessment Group as to whether surgery should proceed.

If agreement to proceed with surgery then follow the above pathway

Last reviewed: 30 April 2022

Next review: 30 April 2025

Author(s): Clinical Director, Surgical Division

Approved By: TAM Subgroup of ADTC

Reviewer Name(s): Clinical Director, Surgical Division

Document Id: COVID115