Consent and Patient Agents Flashcards
VG comes to your pharmacy to obtain a prescription for testosterone 200mg IM
injection once per month. He indicates that his doctor said the pharmacist should
be able to administer the injection for him.
given in gluteal muscle
Depo-Testosterone 100mg/mL injection
You have been trained and have administered IM testosterone injections in
the dorsogluteal site before.
Scenario Interpretation - Consent
- Assessing the patient
- Dispensing a medication
- Injecting a medication
- Provide relevant information to other health care professionals and provincial
health agencies as appropriate
1) Assessing the Patient - Consent
Collecting Information about the Patient / Documenting in Patient Record
● Health Information Act [s.27]
○ Consent is not required
○ BUT - need to collect only the information necessary (i.e. refer to the Standards of Practice for
what is considered as the minimum)
○ BUT - patients must be advised of the reason / purpose that health information is being
collected (verbally or in writing)
Collect on what is necessary only, pt may complain too much but following SOP
● Standards of Practice
○ Consent is not required
○ SOP outlines WHAT information is required
BUT… PROVIDING THE INFORMATION IS
CONSIDERED IMPLICIT OR IMPLIED CONSENT
1) Assessing the Patient - capacity
● Capacity
○ Not defined by the Standards of Practice
○ Minor - Capable minor can make own medical decisions (BASE 3) (mature minor, capable of reasoning)
● Formal Capacity Assessment
○ Personal Directive
○ Co-decision maker
○ Guardian
○ Trustee
■ Office of Public Guardian and Trustee (AB)
● Physician
● Psychologist
● Specially trained nurses, psychiatric nurses, social workers, occupational
therapists
practoca application of capacity
“In legislation, capacity is the ability to understand information that is relevant to
the decision and the ability to appreciate the reasonably foreseeable
consequences of both the decision and the failure to make a decision. If there is
concern about the capacity of the decision maker, an assessment must be
undertaken.”
“Often the best way to assess understanding is to have the patient repeat back
what s/he understood had been said and the reasoning behind the decision
made.”
option talk SDM, teach back, viausl methods, summarize
1) Assessing the Patient - Consent
Documentation of Consent
● Health Information Act
○ Not required if from patient
○ BUT, if collecting information from a patient’s agent, document whom from / rationale why (who its ocming from)
● Standards of Practice
○ Not required
○ If from patient agent, good best practice
IF CONCERN ABOUT CAPACITY ARISES, YOU NEED TO REFER /
DOCUMENT CONCERNS
2) Dispensing a Medication - Consent
Dispensing to the Patient
● Health Information Act ○ Consent is not required ○ Personal health information / record is being disclosed ■ E.g.) Name of patient, drug, etc. - considered health info being provided
● Standards of Practice
○ Consent is not required
○ Physician (prescriber) should have informed consent before prescribing treatment
■ Best practice to verify (3 Prime questions…?) - not practical but courts may look at it if it got to that point
2) Dispensing a Medication - Consent - AGENT
Dispensing to the Patient’s AGENT
● Health Information Act
○ Consent is not required
■ Disclose without consent to individuals (e.g. friends and family) who are providing
continuing care or treatment to the patient [s. 35(1)b]
○ Personal health information / record is being disclosed
■ E.g.) Name of patient, drug, etc.
● Standards of Practice
○ Consent is not required - treat agent like the patient (all other standards)
○ Physician (prescriber) should have informed consent before prescribing treatment
■ Need to verify - ? = discretionary (when in doubt, obtain consent)
2) Dispensing a Medication - Consent - AGENT
Documentation - Dispensing to the Patient’s AGENT
● Health Information Act
○ Disclosure of a record (without consent) must be documented (logged - must be retrievable)
■ Name of the person
■ Date and purpose of the disclosure
■ Description of information disclosed
○ Paper or electronic / log maintained for 10 years
● Standards of Practice
○ Documentation not required, BUT best practice to incorporate as part of HIA requirements
document given to someone other than pt
from HIA not SOP - disclosure log
2) Dispensing a Medication - Consent - AGENT
Written Consent - Dispensing to the Patient’s AGENT
● Health Information Act
○ Patient can provide written consent to the pharmacist
○ Must be informed consent
○ Patient cannot be pressured to provide
○ Must be obtained before disclosure of a health information record
○ Must be written (verbal / implied consent is not valid under HIA)
● Consent elements
○ Name, purpose, intended users, acknowledgement of understanding risk of consent, effective
date, expiry date, statement it can be revoked at any time
form for lawyers, responsibility on you as custodian
● Mature Minor (typically part of common law - not statute)
● Alberta has no set age for a mature minor
○ Court precedence - 16 years of age / none have recognized younger than 14 years of age
● Patient confidentiality [HIA - Sec. 104(1)(b)]
○ “if the individual is under 18 years of age and understands the nature of the right or power and
the consequences of exercising the right or power, by the individual,”
○ Best practice - seek consent (written) before disclosure of health information / records
■ Unless exceptions apply (as defined by HIA)
3) Injecting a Medication - Consent
Informed Consent
● Standards of Practice
○ Obtain informed consent from the patient [SOP 17.1(a)]
● The concept of “informed consent” was developed on the premise of two
distinct components:
■ patients’ rights to determine what happens to their bodies, and
■ health professionals’ inherent duty to provide patients with enough information to make
an informed decision.
● Generally, for a patient’s consent to medical treatment to be acceptable
○ the consent must be voluntary,
○ the patient must have the capacity to consent, and
○ the patient must be properly informed.
3) Injecting a Medication - Consent
Physical Contact - Seek explicit consent
● Disrobing of patient
● Touching the patient
● Best practice is to provide a running commentary BEFORE the action occurs
(explain what you are going to do and why)
○ Provide warning and seek patient consent before proceeding
3) Injecting a Medication - Consent - Minors
Who Can Consent to Treatment for a Minor?
● Emergency - YOU
● Guardian of the child
○ Reasonable to assume parent is guardian of the child
○ Guardian must make decisions in the best interest of the child (professional obligation to
report to child welfare authority if you believe the guardian’s decision is NOT in the best
interest of the child)
○ May need to seek legal agreements / wills / court orders for verification
■ Ideal, copy on file in patient record
■ If not able to, clear note documented in the patient file
4) Other Consent / Disclosure
● Netcare (disclosure without consent) - do not need to keep log as that
information is maintained by Netcare
● Faxed refill requests to prescribers (disclosure without consent) - need to log
disclosure
● Prescription adaptation notifications to physicians (disclosure without consent)
- need to log disclosure
● CACP / SMMAs updates to physicians (disclosure without consent) - need to
log disclosure
● Tax receipts - written consent if disclosing to anyone except the patient
○ Best practice - mail it addressed to the patient
