Nov 9, 2024
Decision making
-The following factors should be considered when determining a patient’s decision-making capacity.
-Is the patient of legal age? Is the patient impaired by alcohol or drug intoxication or serious injury or illness? Does the patient appear to be experiencing significant pain? Does the patient have a significant injury that could distract him from my more serious injury? Are there any apparent hearing or visual problems? Is a language barrier present?
Express Consent: Patient acknowledges and agrees to treatment. The consent must be informed consent, which means that you explained the treatment being offer along with the risk and benefits.
Implied Consent: Applies when a patient is unconscious or incapable of making decisions. (Intoxicated by drugs or alcohol.)
Involuntary Consent: For patients with mental illness or developmental delays; may involve guardians or legal authority.
Minors and Consent: Typically requires parental consent unless the minor is emancipated.
Emancipated minors are people who despite being under the legal age in a given state, can legally be treated as adults based on certain circumstances. (Ex. Married, members of the armed services, or if they are parents.)
-In every state when a parent cannot be reached to provide consent, healthcare providers are allowed to give emergency care to a child.
Patient should understand information and make informed decisions.
Factors affecting capacity: age, impairment, pain, injury, language barriers.
Patients may refuse treatment if they have decision-making capacity.
Document refusals and involve medical control. -Make sure the patient understands everything that you say about the possible consequences of refusing treatment and document everything in your patient care report (PCR).
-If patient appears confused, and you cannot assume the decision to refuse is an informed refusal, providing treatment is usually a much more defensible position than failing to treat a patient! Things like contacting medical direction when you are unsure, and the use of law enforcement are good ways to ensure your own safety.
-Try to encourage the patient at least three times to allow treatment.
-It is essential for you to ask the patient to sign a refusal treatment form and document refusals.
HIPAA regulates the protection of patient information.
PHI (Protected Health Information)
Breaches of confidentiality can lead to legal action. -Confidential information includes a patient history, assessment, findings, and treatment provided… disclosure of this information without proper authorization, may result in liability for breach of confidentiality.
DNR (Do not resuscitate order) Orders: Written document by physician, giving permission to medical personnel, not to attempt resuscitation in the event of cardiac arrest.
Even with DNR you are still obligated to provide supportive treatments, like oxygen, pain, relief, and comfort to a patient who is not in cardiac arrest.
Advance Directive can also be referred to as a Health Care Directive.
Advanced directive is a written document that allows for medical treatment to a patient if he or she becomes unable to make decisions.
Living Wills/Health Care Directives: Specify treatment preferences.
POLST/MOLST Forms: Physician Orders for Life Sustaining Treatment and Medical Orders for Life Sustaining Treatment forms describe acceptable interventions for terminally ill patients. Must be signed by a physician, physician, assistant, or nurse practitioner to be valid.
Durable Power of Attorney: is when patients have a named individual that makes decisions for them regarding their healthcare in the event that they are unable to make such decisions for themselves.
Presumptive signs of death
-Unresponsive to painful stimuli, lack of carotid pulse or heartbeat, absence of chest rise and fall, no deep tendon or corneal reflexes, absence of pupillary reactivity, no systolic blood pressure, profound cyanosis, lowered or decreased body pressure.
Definitive signs of death
-obvious damage such as decapitation, dependent lividity, which is blood, settling to the lowest point of the body, causing discoloration of the skin, rigor mortis which is the stiffening of body muscles, algor mortis when the cooling of the body matches the ambient temperature, and putrefaction which is decomposition of body tissues typically occurs sometime between 40 and 96 hours after death.
Defined by state law and further detailed by medical directors it outlines the care you are legally able to provide for your patient.
Actions outside the scope can be considered negligence.
-Standard of care is how a person with similar training and experience would act under similar circumstances.
This concludes Chapter 3 with a focus on consent, legal duties, and ethical responsibilities in emergency medical care.