Informed contest Flashcards
AMA definition of informed consent
the process of informed consent occurs when communication between a pt and physician results in the pt’s authorization or agreement to undergo a specific medical intervention
the process of obtaining informed consent from a patient is the ______, ______, and ______ responsibility of all health care providers and provides the foundation for a trusting relationship between provider and patient
Moral, ethical and legal
what are the 3 essential conditions needed to obtain informed consent
- the patient must have the capacity & competence to make an informed decision
- the pt must be given adequate clear information about the procedure or treatment & alternatives sufficient to allow him/her to make an informed choice
- the patient must give consent to treatment voluntarily, without coercion, manipulation, or duress
what is the teach back method
explain the concept and then have the patient paraphrase back their understanding of the concept
at what level of understanding should the informed consent process be provided at
the patient’s level of understanding
* example: no medical language
What does PARQ stand for? (acronym used to help the provider remember the information to be disclosed to the pt)
P - recommended medical procedure
A - reasonable alternative to the recommended procedure
R - risks of the procedure
Q - asking the patient if they have any questions
what does shared decision making mean?
both parties share information:
* the clinician offers options and describes their risks and benefits
* the patient expresses his or her preferences and values
what are the 5 exceptions to obtaining informed consent
- emergency exceptions
- patient unable to consent
- patient waiver of consent
- public health requirements
- therapeutic privilege
what is emergency exception to informed consent
when the tx is required to prevent death or other serious harm to a patient, that treatment may be provided without informed consent
patients unable to consent means
care of patients who lack decision-making capacity can be provided without the patient’s informed consent
patients waiver consent means
patients who choose to waive their rights to receive the relevant information and give informed consent to treatment
public health requirements refers to
- sometimes medical interventions have a potential benefit to the patient and others in the community.
- in these instances, public health statues may authorize patient attention or tx without the patients consent
- overrides patient’s autonomy in specific circumstances to protect the public health’s interest
therapeutic privilege refers to
allows healthcare provider to let considerations about the physical, mental, & emotional state of the patient affect what info is disclosed to the pt
what should you do/document after obtaining informed consent
verify that the pt was given the opportunity to ask questions and discuss concerns
What is discharge against medical advice?
: When a patient chooses to leave a hospital before the healthcare team recommends discharge from the hospital.
What are the MCC of DAMA?
- Most frequently reported in patients with a history of substance abuse (23%); this includes alcohol abuse and/or intravenous drug abuse.
- Other Conditions: Psychiatric diagnoses (20%), HIV infection (13%), Heart Failure (4.9%), Asthma (4%)
- Sickle-cell disease: 2.4% risk of leaving AMA
Consequences of Leaving AMA (4)
- Readmission: The risk of readmission is more than doubled for patients leaving AMA compared to planned discharge, and that risk remains high for a long time. We should still expect readmission of those patients who left AMA up to one year after discharge.
- Length of Stay: Higher risk of staying in the hospital almost double the time they are expected to stay should they be discharged formally.
- Cost of Readmission: 56% higher than if the patient were to have a planned discharge.
- Increased Mortality: The mortality risk for those who leave against medical advice is double 28 days after discharge.
Prevention Strategies for AMA
* What should you do as a provider?
Understanding a patient’s reasons & trying to address them.
Prevention Strategies for AMA (4)
- Formulate a management plan that takes the patient’s aspects as a whole rather than focusing on clinical entities alone.
- Involving the patients in the decision-making process by addressing their extra-clinical concerns will improve their agreement with the management plan and decrease the chances of them leaving AMA.
- Nurses’ Factors: Most of the time, nurses are the first to identify the patients who are willing to leave against medical advice. Nurses’ contribution to the development of new strategies is of utmost importance.
- A Team-based Approach
What do you need to do if patient leaves AMA?
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