With the patient’s permission, speak with family, clergy or another mediator if you think this might help the patient reconsider his or her refusal. Document your efforts to educate the patient, the rationale for your recommended treatment, and the patient’s refusal of care. Ask the patient to sign a refusal of care form.
Full Answer
How do you deal with a patient who refuses treatment?
Educate the patient as fully as possible about the benefits of treatment recommendations and the risks of no treatment. As much as possible, discover the patient’s reasons for refusing care and discuss these with the patient to see if there are ways to negotiate so that the patient can receive care that is in his or her best interests.
Do I need to document a patient’s refusal of treatment?
If your answer is yes, no need to keep reading. But if you answered no, here’s an important point to consider: documenting patients’ refusal of treatment is just as important—maybe even more so—than documenting patient consent. Obtaining informed consent is a well-established administrative protocol in most practices.
How do you handle informed refusal?
Handle informed refusal as a natural extension of your informed consent process. “You want to approach it in the same way [as informed consent],” says Kichler. That means steps like assessing the patient’s competence, providing verbal and written information in language patients can understand, and using the patient teach-back method.
What should you do when patients resist your treatment recommendations?
When patients express resistance to your treatment recommendations, pay attention to what they’re really saying. Follow the principles of shared decision making and patient-centered care to help patients identify what is most important to them and pinpoint their concerns about your prescribed path of treatment. Take the patient seriously.
How do you handle patient refusal?
Taking the following steps can protect your patients' rights and your practice.Patient Education, Understanding, and Informed Consent. ... Explore Reasons Behind Refusal. ... Involve Family Members and Caregivers. ... Document Your Actions. ... Keep the Door Open.
What do you do when someone refuses medical treatment?
What to Do if Your Loved One Refuses to See a DoctorBe transparent and direct. ... Convince them that it's their idea. ... Make it a "double-checkup" ... Make the rest of the day as enjoyable as possible. ... Get someone who is an authority figure to help.
What is the nurse's legal and ethical responsibilities toward the patient who refuses medical care or treatment?
All clients have the legal right to autonomy and self-determination to accept or reject all treatments and interventions. With the exception of emergencies, all aspects of nursing care and interventions must be explained to the patient.
What 3 elements must a patient demonstrate in order for a refusal to be lawful?
3) In order for a patient to refuse treatment and/or transportation two events must occur to protect both the patient and yourself: 1) You must give the patient enough information about the decision Page 2 2 they are making so that there is an informed consent, and; 2) You must be satisfied that the patient has ...
What do you do when the family of a patient refuses to acknowledge the client's condition and treatment plan?
When patients, families disagree on treatment: 6 ways forwardGet to know the patient's family. ... Minimize confusion. ... Help everyone identify their values. ... Encourage the patient to be open. ... Preserve confidentiality. ... Don't hesitate to call in help.
How do you document patient refusal?
DOCUMENTING INFORMED REFUSALdescribe the intervention offered;identify the reasons the intervention was offered;identify the potential benefits and risks of the intervention;note that the patient has been told of the risks — including possible jeopardy to life or health — in not accepting the intervention;More items...
What should a nurse do if a patient refuses treatment?
If your patient refuses treatment or medication, your first responsibility is to make sure that he's been informed about the possible consequences of his decision in terms he can understand. If he doesn't speak or understand English well, arrange for a translator.
What actions should a nurse implement when a client refuses a treatment?
If the client refuses a treatment or procedure, the client signs a document indicating that he understands the risk involved with refusing the treatment or procedure and that he has chosen to refuse it. The nurse asks the client to sign an "Against Medical Advice" form and documents the incident.
What is the role of a nurse when a client refuses treatment?
1. Because a client legally has the right to refuse medication, the nurse can only recommend, advise, suggest, or urge the patient to comply. Consequently, it is important to understand the nurse's response to patient refusal of medication.
What 3 factors must you consider for valid consent?
Defining consent For consent to be valid, it must be voluntary and informed, and the person consenting must have the capacity to make the decision.
What are the 3 main requirements of valid consent?
That is, the patient must have capacity to consent, the consent must be freely given and be sufficiently specific to the treatment, and the patient must be informed about the procedure and any material risks.
What are the 4 principles of informed consent?
There are 4 components of informed consent including decision capacity, documentation of consent, disclosure, and competency.
How to reduce refusals in therapy?
The right attitude, approach, and activity can make therapy easier and reduce refusals, but sometimes you need added help. Refusals can feel personal. Most therapists have developed conscious and subconscious defense mechanisms related to these remarks.
What does it mean when a patient refuses therapy?
Statements like “Maybe tomorrow?” or “I don’t want to do it today” can mean that the patient isn’t seeing the value of the therapy sessions.
How many refusals of therapy do skilled nursing therapists get?
Standard in every skilled nursing therapist’s day is dealing with patients’ refusal of therapy. A typical SNF therapist averages 1-2 refusals of treatment each day. That can be 15-20 percent of a therapist’s day that’s canceled!
Why is it important to know when a patient doesn't get enough sleep?
This means letting the care team know when a patient doesn’t get enough sleep because of a loud roommate or a patient didn’t eat because the food got too cold.
Can adjusting to a new medication make therapy more difficult?
Patients may be adjusting to a new medication, still healing from a recent procedure or have any number of clinical challenges that can make therapy more difficult. Speak to interdisciplinary team members to see if they have also received concerns and what subsequent actions have been taken
Can a therapist cajole a patient to join a therapy session?
Often, a motivated therapist can cajole a patient to join the scheduled therapy session. But many times, it’s simply easier for a busy therapist to let a tired or distracted patient skip a session.
What is the first step in a mental health case?
The first is to determine the urgency of treatment to see whether common law is applicable. The second is to determine what is being treated—a primary physical (organic) disorder or a primary mental (psychiatric) disorder. We will now explain how to work through these two steps as we look at the evolving case scenario.
When acting against a patient's wishes, is the MCA used?
As a general rule, when acting against a patient’s wishes, the MCA is used to treat physical disorders that affect brain function and the MHA is used to treat primary mental (psychiatric) disorders. In part two of the case scenario the patient’s behaviour has changed.
What is common law in emergency settings?
In the first part of the case scenario, failure to act immediately and treat the tension pneumothorax would probably result in serious harm to the patient. In such situations there is clearly not sufficient time for a formal assessment of capacity and common law should be used. Common law is widely used in emergency settings, because there is rarely time for consent. Clinicians are often unaware that they are using it and that it is the legal defence of their actions. No specific documentation is needed when using common law. However, the MCA and MHA should be the default legal frameworks when the situation is not immediately life threatening. Box 2 lists the key principles of common law.
What is the purpose of MHA?
The MHA can be used only to treat patients with a mental disorder, including those due to physical health conditions (such as delirium). It can also only be used in situations where there is concern about patient’s health or safety, or the safety of others.
When can MCA be used?
Summary points. Common law can be used to treat patients in emergencies, especially when the diagnosis is unclear. It allows necessary and proportionate restraint until Mental Capacity Act (MCA) or Mental Health Act (MHA) assessments are completed. The MCA can be used to restrain and treat patients without capacity (for a specific decision) ...
When is common law relevant?
Since implementation of the MCA, common law is now relevant only in emergency situations when there is insufficient time to assess an individual’s capacity. The MCA (box 1) was implemented in 2007 and codified (detailed) previous common law on the treatment of those without capacity.
Is common law a doctrine of necessity?
View inline. Common law is more informatively known as the “doctrine of necessity” and is only one form of common law, which is based on judgments of individual cases (also known as case law). This differs from statutory law, which is based on acts (of parliament), such as the MCA and the MHA.
What is informed refusal?
INFORMED REFUSAL. Texas law recognizes that physicians must obtain consent for treatment and that such consent be "informed.". A variant of informed consent is informed refusal, in which a patient refuses treatment after having been informed of the risks and benefits of the intervention. Many physicians associate the concept ...
What is the failure to use ordinary care?
Negligence is the failure to use ordinary care, that is, failure to do that which a health care provider of ordinary prudence would or would not have done under the same or similar circumstances. One of the main issues in this case was documentation.
What temperature was the patient's fever during his 3 day hospital stay?
The patient had a fever of just above 100 degrees every day during his 3-day admission, including the day of discharge. According to the cardiologist, but not documented in the patient's medical record, the patient declined cardiac catheterization and wanted to be discharged home.
What is prudent practice?
Prudent practice involves comprehensive documentation. As with the informed consent process, informed refusal should be documented in the medical record. In the case study, the jury found in favor of the plaintiffs when faced with a deceased patient and an undocumented patient decision of great importance.
How much did the jury award in the case of the syringe?
The jury found the physician negligent and awarded damages of approximately $50,000 for funeral costs, medical expenses, and past mental anguish.
Can refusal to consent to a recommended intervention lead to a lawsuit?
However, as the case study illustrated, a patient's refusal to consent to a recommended intervention can occur under a variety of circumstances, and can lead to lawsuits involving allegations of failure to treat or failure to inform. "Implicit in and intrinsic to the concept of consent for treatment is the option of refusal.
Was bypass surgery appropriate?
Had the disease been too extensive, bypass surgery might have been appropriate . Defense experts believed the patient was not a surgical candidate. They were supportive of the cardiologist's decision not to perform a cardiac catheterization in accordance with the patient's wishes.
What is informed refusal?
Informed Refusal. The concept of informed refusal is the flip side of informed consent. Informed refusal acknowledges that every competent patient has the right to refuse a recommended test, procedure or treatment but requires the physician or healthcare provider to inform the patient of the risks of that refusal.
What are the factors that affect the patient's willingness to undergo surgery?
Juries may factor in the patient’s willingness to undergo surgery, which could potentially result in infection, bleeding, injuries to adjacent organs, and death when weighing the patient’s allegation that they would not have undergone a procedure if they had known about the complication of something more minor.
Is the consent process after the fact?
The practice of documenting the consent process after the fact (e.g. in an operative note) could be viewed as self-serving if there is an adverse event. The most thorough informed consent process may be negated if there is no contemporaneous documentation to evidence that such a process took place.
