I agree that if someone is not providing care for the patient then thy should not be able to have access to the patient's chart but in reality that happens all the time for simply collecting data. For example, at a hospital that I used to work for when patients suddenly die or have a change in mental status and becomes combative, meetings are held with all that where involved in the care to go over the care and see if things could have been done differently. If consent had to be obtained for everyone of those cases it would delay the process and potentially delay improvement to hospital policies.

According to Melykn and Fineout-Overholt(2015), EBQI is systemic, evidence-based activities designed to immediately improve healthcare delivery in specie settings. With this definition it is understood that EBQI is or should be apart of routine clinical practice. Debate over informed consent can be seen as a question of whether patients should expect EBQI to be seen as part of standard healthcare practice. One could argue that much of EBQI is good clinical care including systematic and experimental learning. Individual practitioners are constantly learning by doing and taking steps to improve their own practice. EBQI activities play a role in this, and as such, professionals and organizations have

an ethical responsibility to conduct EBQI projects to demonstrate whether or not change

improves outcomes. This understanding of EBQI also places a responsibility on patients to participate in such activities.In that case, informed consent would not be necessary.

Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing & healthcare (3rd Ed.). Philadelphia, PA: Lippincott Williams & Wilkins.