1. NORTH AMERICAN HEALTHCARE INFORMED CONSENT

2. RESIDENT RIGHTS Make decisions Accept or refuse treatment Be free from any physical/chemical restraints Receive information related to risks of physical/chemical restraints

3. RESPONSIBILITIES OF ATTENDING PHYSICIAN Obtain informed consent –Prior to the 1 st use of physical/chemical restraint; –Chemical restraint dosage outside of the dosage range covered by the previous consent Verification of informed consent to the facility Determine resident’s decision making capacity Seek consent of capable residents to notify interested family member –For reasonable attempts within 48 hours of the new order or increase in existing orders

4. OTHERS Facility’s responsibility: –Documenting verification of informed consents Physical/chemical restraint: –Informed consent still required after assessed Treatment may be initiated without informed consent –Documentation of emergency

6. PHYSICIAN DETERMINES RESIDENT’S CAPACITY Makes a determination of the resident’s capacity Document his/her ability for decision-making; If determined not capable of his/her own decision-making, surrogate decision-making shall receive the same information –Conservator provides informed consent, the conservatorship papers must be on file for “powers for medical decision-making and limitations”

7. INFORMED CONSENT Facility staff shall: –Verify that the resident’s record contains documentation the resident has given informed consent before: Initiating the administration of physical/chemical restraints/psychothepeutic drugs; Prolonged use of a device Informed consent can be obtained [ ] specific medication dosage [ ] dosage range (in compliance with therapeutic dosage ranges as specified by federal guidelines. Specify based on facility pharmacy policies/procedures

8. INFORMED CONSENT -2 Facility staff shall: –Verify the resident has given informed consent… If a dosage range is used for the original informed consent, a new consent will not be obtained unless the dosage increases and falls outside of the original range and/or material circumstances or risks change (as determined by the physician). The resident’s representative shall still be notified of any increase in medication even if in a range.

9. INFORMED CONSENT -3 Withholding disclosure of risks –There is documentation of one of the following: Resident / representative / surrogate decision-maker specifically requested not to be informed; Disclosure would upset the resident Do NOT dismiss the physician’s duty to obtain informed consent

10. INTERPRETER Facility shall arrange for a fluent interpreter if a resident, when needed. Record shall reflect the interpreter’s name and relationship

11. VERIFICATION PROCESS FOR INFORMED CONSENT Physician or other health professional: –Verify that the resident / surrogate decision- maker gave the information, i.e., the need for the physical/chemical restraint/therapeutic drug Telephone verification of informed consent with two witnesses Documentation of verification of informed consent by the physician progress note Use of a facility verification form or statement

12. CAPACITY TO MAKE DECISIONS Attending physician –Advises the facility of the resident’s capacity, usually a part of the history & physical examination –Indicates if a surrogate decision-maker is available –Indicates if the resident is incapable and not one is available

13. SURROGATE DECISION-MAKER IDENTIFICATION The surrogate decision-maker shall be decided by the physician if no surrogate decision-maker designated by a Power of Attorney for Health Care or an Individual Health Care Instructions, or a conservator. Decision shall be indicated on: [ ] Orders [ ] History & Physical examination [ ] Progress Notes [ ] Other

14. IDT – DECISION-MAKING PROCESS Facility will appoint an “Interdisciplinary Team” (IDT) when resident lacks decision- making capacity and there is no person with legal authority. IDT members: –Resident’s physician –Registered nurse –Other appropriate staff IDT will oversee the resident’s care and make periodic evaluations at least quarterly.

15. IDT – DECISION-MAKING PROCESS -2 IDT will review the physician’s proposed medical intervention and address –Physical assessment –Resident’s capacity –Unavailability of a surrogate –Evidence of the resident’s whiles, while competent –Reason for the proposed medical intervention –Type of medical intervention being proposed –Probable impact of intervention –Reasonable alternative medical intervention(s)