health care profile vamc- informed consent presentation

7/30/2019 Health Care Profile VAMC- Informed Consent Presentation

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INFORMED CONSENTCompany Name

Health Care ProfileProject of

VAMC

SIGN HERE


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The VAMC is part of a network of government healthcare facilities that

service the Upstate New York area.

The VA Medical Center has an active affiliation with the State University of

New York Upstate Medical University where over 650 of their students,

residents, interns, and fellows receive training at the Medical Center each

year.

This network functions out of six medical centers and thirty community

based outpatient clinics

The VAMC at-a-glance


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The VA has extensive and comprehensiveservices that are offered in a 106-bed general

medicine and surgical facility for Veterans and their

families through ten specialties: Primary care,

Mental Health care, Tertiary care, Long-term care,

Physical medicine, Rehabilitation, Neurology,Oncology, Dentistry, and Geriatric.

The VAMC at-a-glance contd


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Informed consent is a legal doctrinethat provides that a patient has the

right to know the potential risks,

benefits, and alternatives of a

proposed procedure. (Pozgar, 2007,

p. 278)

InformedContent


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Informed Consent contd

According to the Veterans Healthcare Administration (VHA)Handbook 1004.1 (DVA, 2009) the definition of informedconsent is further delineated by the differentiation betweencompetency and capacity.

The handbook states, Competency is a legal determinationmade by a court of law that a patient has the requisitecapacities to make a medical decision. (p. 1).

Decision-making capacity, is a clinical determination made

by the practitionerthe patients ability to understand andappreciate the nature and expected consequences of eachhealth care decisionand the ability to formulate a judgmentand communicate a clear decision concerning health care.(p. 2).


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Informed Consent Development

Nuremberg Code of 1947

Schloendorff 1914

Natanson 1960

Salgo 1957

Canterbury 1972

Candura 1978 Healthcare Truth and

Transparency Act of 2011

Mandate of proper and ethicaltreatment of patients

Doctrine of Informed Consent

Ensure that patients receiveaccurate healthinformationin the provisionof health care services

Laws/Cases Healthcare Outcome


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Informed Consent Process

In order to obtain signature informed consent,

the practitioner must determine whether the

patient has decision-making capacity.

Patients are presumed to have decision-making capacity unless an appropriate clinical

evaluation determines that the patient lacks

decision-making capacity, or the patient is a

minor, or the patient has been ruled

incompetent by a court of law.


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The practitioner must perform (or

obtain) and document a clinicalassessment of decision-making

capacity for any patient

suspected of lacking decision-

making capacity.


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Provide information in understandable language

Clear, concise

Details of the procedure, likelihood of success,

expected risks and benefits, reasonable alternatives Name and profession of primary practitioner

Advise patient of his/her responsibilities during

recuperative period

Advise patient if the treatment is novel orunorthodox

Ensure that the patient indicates understanding

Encourage the patient to ask questions


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Practitioners assessment of the patients decision-making

capacity

Name of all practitioners

Brief description of the procedure

A statement that all relevant aspects including indications,risks and benefits, alternatives including NO treatmenthave been discussed in easy to understand language andthat the patient understood and had an opportunity to askquestions without coercion

Date, time, and signature of practitioner

Documentation


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Documentation

Treatments that DO NOT require signature consent are:

Treatments and procedures that are low risk and are WITHINBROADLY ACCEPTED STANDARDS OF MEDICALPRACTICE (e.g. administration of most drugs or for theperformance of minor treatments such as routine x-rays) do notrequire signature consent.

Signature consent is not required for routine injection of contrastmedia for imaging procedures.

However,the informed consent process must bedocumented in the medical record. In accordance with VHAPolicy on documentation of patient records, documentationmust be sufficient to serve as a basis to plan patient care,

support diagnoses, and warrant treatment.


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Documentation

In medical emergencies, the patients consent is impliedby law. The practitioner may provide necessary medicalcare when ALL of the following are met:

Immediate care is needed to preserve life or avert serious

impairment Patent is unable to consent

No surrogate is available or waiting to obtain would do harm

Reasonable attempts to contact surrogate must be made aspromptly as possible to explain nature, indications, and expectedoutcome

Advance Directives are to be followed if available

Documentation must include-the patients inability to provideconsent, imminent danger, rationale for decision to undertakeprocedure, and attempts to contact surrogate with specifics

Executive Chief of Staff must sign and date consent


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Documentation

Separate signature informed

consent for Anesthesia

Separate Anesthesia progress

note


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Decision-making capacity

Separate consent for Anesthesia

More requirements for documentation

Medical emergencies

KEY POINTS


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Conclusion

There are many factors that

may contribute to a

providers inability to

provide the information

necessary to receive apatients informed consent.

Ethically and legally, it is still

the providers responsibility

to provide the necessaryinformation in a way that

ensures understanding,

patient safety, and the

provision of equitable,

patient-centered healthcare.

Additionally, it is thehealthcare facilitys ofwhich the provider isworking through that isresponsible for making

sure that all providers whoparticipate in theinformation process of apatients treatment and/orprocedure is fully,competently, and equally

trained as their seniorcounterparts. This is theprocess that must beenhanced at the VeteransAdministration MedicalCenter.


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Recommendations

Consistent training of Residents and Fellows

Medical Center Policy that upholds the requirementfor standard training among rotating providers

Consistent rotation schedule for training that mirrorsthe rotation schedule of the Residents and Fellows

Quick but, comprehensive and effective trainingprogram


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THE END

DOCUMENT EVERYTHING!!!


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Pozgar, G.D. (2007). Legal aspects of health

care administration 10th ed. Massachusetts:Jones and Bartlett

U.S. Department of Veterans Affairs. (2009).

VHA Handbook (1004.01): Informed consentfor clinical treatments and procedures.Retrieved fromhttp://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2055 on February 22, 2011

References
http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2055http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2055http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2055http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2055

health care profile vamc- informed consent presentation

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