Informed contest

Question 1

AMA definition of informed consent

Answer 1

the process of informed consent occurs when communication between a pt and physician results in the pt’s authorization or agreement to undergo a specific medical intervention

Question 2

the process of obtaining informed consent from a patient is the ______, ______, and ______ responsibility of all health care providers and provides the foundation for a trusting relationship between provider and patient

Answer 2

Moral, ethical and legal

Question 3

what are the 3 essential conditions needed to obtain informed consent

Answer 3

1. the patient must have the capacity & competence to make an informed decision
2. the pt must be given adequate clear information about the procedure or treatment & alternatives sufficient to allow him/her to make an informed choice
3. the patient must give consent to treatment voluntarily, without coercion, manipulation, or duress

Question 4

what is the teach back method

Answer 4

explain the concept and then have the patient paraphrase back their understanding of the concept

Question 5

at what level of understanding should the informed consent process be provided at

Answer 5

the patient’s level of understanding
* example: no medical language

Question 6

What does PARQ stand for? (acronym used to help the provider remember the information to be disclosed to the pt)

Answer 6

P - recommended medical procedure
A - reasonable alternative to the recommended procedure
R - risks of the procedure
Q - asking the patient if they have any questions

Question 7

what does shared decision making mean?

Answer 7

both parties share information:
* the clinician offers options and describes their risks and benefits
* the patient expresses his or her preferences and values

Question 8

what are the 5 exceptions to obtaining informed consent

Answer 8

1. emergency exceptions
2. patient unable to consent
3. patient waiver of consent
4. public health requirements
5. therapeutic privilege

Question 9

what is emergency exception to informed consent

Answer 9

when the tx is required to prevent death or other serious harm to a patient, that treatment may be provided without informed consent

Question 10

patients unable to consent means

Answer 10

care of patients who lack decision-making capacity can be provided without the patient’s informed consent

Question 11

patients waiver consent means

Answer 11

patients who choose to waive their rights to receive the relevant information and give informed consent to treatment

Question 12

public health requirements refers to

Answer 12

• sometimes medical interventions have a potential benefit to the patient and others in the community.
• in these instances, public health statues may authorize patient attention or tx without the patients consent
• overrides patient’s autonomy in specific circumstances to protect the public health’s interest

Question 13

therapeutic privilege refers to

Answer 13

allows healthcare provider to let considerations about the physical, mental, & emotional state of the patient affect what info is disclosed to the pt

Question 14

what should you do/document after obtaining informed consent

Answer 14

verify that the pt was given the opportunity to ask questions and discuss concerns

Question 15

What is discharge against medical advice?

Answer 15

: When a patient chooses to leave a hospital before the healthcare team recommends discharge from the hospital.

Question 16

What are the MCC of DAMA?

Answer 16

• Most frequently reported in patients with a history of substance abuse (23%); this includes alcohol abuse and/or intravenous drug abuse.
• Other Conditions: Psychiatric diagnoses (20%), HIV infection (13%), Heart Failure (4.9%), Asthma (4%)
• Sickle-cell disease: 2.4% risk of leaving AMA

Question 17

Consequences of Leaving AMA (4)

Answer 17

• Readmission: The risk of readmission is more than doubled for patients leaving AMA compared to planned discharge, and that risk remains high for a long time. We should still expect readmission of those patients who left AMA up to one year after discharge.
• Length of Stay: Higher risk of staying in the hospital almost double the time they are expected to stay should they be discharged formally.
• Cost of Readmission: 56% higher than if the patient were to have a planned discharge.
• Increased Mortality: The mortality risk for those who leave against medical advice is double 28 days after discharge.

Question 18

Prevention Strategies for AMA
* What should you do as a provider?

Answer 18

Understanding a patient’s reasons & trying to address them.

Question 19

Prevention Strategies for AMA (4)

Answer 19

• Formulate a management plan that takes the patient’s aspects as a whole rather than focusing on clinical entities alone.
• Involving the patients in the decision-making process by addressing their extra-clinical concerns will improve their agreement with the management plan and decrease the chances of them leaving AMA.
• Nurses’ Factors: Most of the time, nurses are the first to identify the patients who are willing to leave against medical advice. Nurses’ contribution to the development of new strategies is of utmost importance.
• A Team-based Approach

Question 20

What do you need to do if patient leaves AMA?

Answer 20

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