A3 Informed Consent, Capacity And Competency Flashcards
Information: what is a critical part of the pre-hospital management and decision-making process?
Establishing the competency and capacity of a patient or person responsible. The patient or other persons responsible must display competency and capacity in order to provide informed consent.
What is competency? Who can demonstrate competency?
Competency refers to a person’s status, under law, to be able to make a decision about their healthcare and well-being
Competency is demonstrated in patients without chronic compromise of cognitive function e.g. intellectual impairment or profound dementia
What is capacity? Why may a usually competent person lack capacity?
Capacity refers to the patients acute ability to make a decision about their health care or treatment at the time of assessment.
A usually competent person may lack capacity due to a range of circumstances such as:
- unconscious or altered level of consciousness
- head injury
- high levels of intoxication (drugs and or alcohol)
- mental illness
What are the criteria valid consent? What are the three types of consent?
The consent is given freely.
The consent is given voluntarily.
The patient is demonstrated to be competent and have the capacity to give consent.
The consent is specific and informed.
Expressed (written or verbal).
Implied.
Person responsible.
When is consent not required?
In an emergency, where the patient is unable to give consent and the treatment is required immediately:
To save the persons life
To prevent serious injury to a person’s health or except in the case of special medical treatment, to prevent the patient from suffering or continuing pain or distress or
When a decision is made to transport the patient under section 20 of the mental health act 2007
When may emergency treatment be carried out on children and young persons?
A child (person aged under 16 years) or young person (aged 16 or 17) without the consent of the child, young person or parent if the paramedic is of the opinion that it is necessary, as a matter of urgency, to carry out treatment on the child or young person in order to save his or her life, or to prevent serious damage to his or her health. This is pursuant to section 174 of the children and young persons (care and protection) act 1998.
When may non-emergency treatment be carried out on a person aged under 14 years without the consent of a parent and person responsible?
It cannot.
Can a child aged greater than or equal to 14 years of age consent to their treatment?
Yes, if they have demonstrated competency and capacity.
Should you seek consent of the child’s parent or guardian prior to treatment for children aged 14 or 15?
Yes, unless the child objects.
What documentation is required around informed consent, capacity and competency?
The documentation must be clear and precise and is especially important patient is not transported. It must show the patient was competent and had capacity to consent or refuse treatment and/or transport.
It must make specific reference to the following:
- Receive: can the patient listen and concentrate sufficiently to receive the information being disclosed to them?
- Believe: can the patient understand, accept and believe the information being disclosed to them?
- Retain: can the patient remember the information being disclosed for long enough to consider and analyse? Do they demonstrate the ability to remember information after the paramedic has left the scene?
- Explain: can the patient explain the information they have received and the risks involved with non-transport in their own words?
