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AHS Consent Policy

Background. AHS implemented a new Consent policy effective 31st October 2010It replaces all existing consent policies throughout Alberta There are some significant changes in current practice for obtaining consent. Aim. The purpose of this presentation is to introduce the new consent policy and t

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AHS Consent Policy

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    1. AHS Consent Policy Summarizing and understanding the changes and implications for practice in adult acute care settings Developed by: Lyndsay Clarke RN RDRHC ICU November 2010 (revised)

    2. Background AHS implemented a new Consent policy effective 31st October 2010 It replaces all existing consent policies throughout Alberta There are some significant changes in current practice for obtaining consent

    3. Aim The purpose of this presentation is to introduce the new consent policy and to highlight major changes of practices from the former DTHR policy in the acute care environment. It is not intended to replace the need for a thorough review of the entire policy and procedures.

    4. Where To Find Information Insite.albertahealthservices.ca/2270.asp The new Consent policy, procedures, forms and algorithms can be found on the above web page. All staff are requested to review and become familiar with the new policies and forms before RDRHC roll out on December 1st 2010

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    6. What are the Differences between the Policies? The old DTHR Consent for care and Treatment Policy CC-II-10 has been replaced by: The new AHS policy “Consent to Treatment/Procedure(s)” PRR-01 And 5 new specific treatment/procedures for different situations and care groups. (PRR 01 -01 to 05)

    7. What Are The Five Specific Treatment / Procedures? Adults with capacity (PRR-01-01) Adults with impaired capacity and adults who lack capacity (PRR-01-02) Minors/Mature Minors (PRR-01-03) Formal patients and persons subject to Community Treatment Orders under the Mental Health Act (PRR-01-04) Human tissue and organ donation (PRR-01-05)

    8. Change in Consent Forms ALL consent forms in AHS will be replaced by three new consent forms: 1. Consent to Specific Treatment/ Procedure (#09741) 2. Tissue and/or Organ Donation Consent (#09816) 3. Community Treatment Decisions Consent (#09565)

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    11. What’s new? While there are many similarities in the policies and procedures, there are also many changes. This document is intended to highlight the main changes that may affect acute care settings. Please ensure you read the full policies and forms to become familiar with all of the changes and new definitions/terms.

    12. Most Responsible Health Practitioner (MRHP) Most Responsible Health Practitioner: “the Health Practitioner who has responsibility and accountability for the specific Treatment/Procedure(s) provided to a Patient and who is authorized by Alberta Health Services to perform the duties required to fulfill the delivery of such a Treatment/Procedure(s) within the scope of his/her practice.” i.e. - in order to gain and provide informed consent you must now be capable of performing the procedure for which you are obtaining consent

    13. Major Changes for Acute Care Settings Only the Most Responsible Health Practitioner (MRHP) may now provide and gain informed consent from the patient “Prior to the Patient signing the Consent Form, the Most Responsible Health Practitioner shall ensure that the name of the specific Treatment/Procedure(s) is filled in. No abbreviations shall be used on the Consent Form.” (PRR-01-01, Section 5.5c)

    14. When Consent Is Required Requirement for consent: Before a procedure or treatment is provided there must be express or implied consent unless a valid exception applies, e.g. in an emergency (PRR-01, Section 1.1)

    15. Informed Consent All types of consent must be informed: ” The Most Responsible Health Practitioner providing a Treatment/Procedure to a Patient has a duty to inform the Patient of the nature of the Treatment/Procedure, its risks and benefits, alternatives, and consequences.” (PRR-01 policy statement)

    16. Implied Consent May be presumed when the pt presents voluntarily for an examination, investigation, minor or less invasive treatment/procedure which the MRHP determines does not require express consent. Implied consent must still be informed. If there is any doubt that there is implied consent, the MRHP must obtain express consent.

    17. Express Consent When the MRHP determines that express consent is required, there are 2 options: Verbal consent – shall be documented by the MRHP in the pt's health record Written consent - shall be obtained via the consent form procedure and be attached to the pt's health record (PRR-01 1.4)

    18. Criteria for Written Consent The old DTHR policy made specific rules regarding which procedures required written consent. It included OR procedures, transfusions of blood products, invasive procedures and any procedure which may have been considered to prove potentially damaging to the health of the patient, or where there was a risk of invasion of privacy or security or any research. (CC-II-10 1.2.2)

    19. New criteria for written consent “The Most Responsible Health Practitioner is responsible for ensuring that there is valid and informed consent for any given Treatment / Procedure(s) and is also responsible for determining the most appropriate method of obtaining that consent. Informed Consent may be expressed verbally or in writing, or be implied.” Please note: “Express written consent shall be obtained for the transfusion of blood and blood products.” (PRR-01, Section 1.3)

    20. Documenting Consent Outcomes The MRHP is responsible for ensuring appropriate documentation of the consent process and outcomes on the patients health record. Specifically, the following outcomes shall be recorded: a. Agreement to treatment/procedures b. Refusal of treatment/procedures c. Withdrawal of consent previously given (PRR-01 7.1)

    21. Major Changes for Acute Care Settings In the old DTHR policy (1.4.1.3) Dr’s could sign a double Dr consent for patients who lack capacity to consent. In the new AHS policy for those patients who lack capacity this may happen ONLY where immediate treatment/procedure is necessary to: Preserve the adult’s life Prevent serious physical or mental harm to the adult Alleviate severe pain (PRR-01-02, Section 5.1a)

    22. Major Changes for Acute Care Settings In adults who lack capacity, the new policy specifies (in a designated order) who may provide consent for the patient once a lack of capacity has been established. (PRR-01-02, Section 3) The old DTHR policy did not specify an order for persons authorized to give consent (CC-II-10 1.4)

    23. When a Patient is Determined “To Lack Capacity to Give Consent” The physician, nurse practitioner or dentist (for dental care only) completes the required ‘Assessment of Capacity’ prescribed in the Adult Guardianship and Trusteeship Act regulations (Part One of Form 6 from the Office of the Public Guardian: Specific Decision-Making)

    24. When a Patient is Determined “To Lack Capacity to Give Consent” (cont’d)

    25. Specific Decision-Makers The physician, nurse practitioner or dentist selects the nearest relative of the patient to be the Specific Decision-Maker from the following list in ranked order: spouse or adult interdependent partner adult son or daughter father or mother adult brother or sister grandfather or grandmother adult grandson or granddaughter adult uncle or aunt adult nephew or niece

    26. Specific Decision-Makers May Not: Make health care decisions where a decision respecting the provision of, withdrawal of, or withholding of health care would be likely to result in the imminent death of the Adult (PRR-01, Section 8.2) Make mental health decisions for formal patient(s) or person(s) subject to Community Treatment Orders

    27. Consent for Patient Bloodwork Following a Needlestick Injury Previous DTHR practice did not require patient consent to draw blood following a needlestick injury New AHS Consent policy states that: A patient may refuse to consent to blood testing for HIV, Hepatitis B, and Hepatitis C. In the event of the exposure of a Health Practitioner to a patient’s bodily fluids where a blood borne virus is suspected, and the patient refuses to consent to blood testing, the Health Practitioner should immediately contact Workplace Health & Safety.

    28. Rolling It Out As the consent forms become available and physicians and nursing staff become comfortable with the new policy, we will begin to use the new forms. Full implementation of the forms will be by Dec 1st. Any old consent forms signed prior to Dec 1st will still be valid. Any forms signed after Dec 1st MUST be on the new forms.

    29. Next Steps Be ready to roll out with the new forms and policies and assist those around you to transition to the new system by Dec 1st! Click on the link below and become familiar with full policies and algorithms Insite.albertahealthservices.ca/2270.asp

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