Consents for psychotropics

[maxthecat]

In my state staff is required to obtain consent before administering any psychotropic medication. For everyday practice, this works fine. The patient is given information about the medication, possible side effects, etc. and either consents or refuses.

If they refuse the medication is not administered and they talk about it with their psychiatrist to try to find a med that is mutually acceptable. Fine.

Recently we have been told that we must have consent for administering any emergency psychotropic also. Problem is, if a patient is so agitated as to need an emergency med, they are also likely to be too agitated to consent. Yes, we can offer, but they will likely refuse. The psychiatrist will then say, this is an emergency, they are a danger to themselves and others, give the med anyway. I could live with this, but management is now holding nursing responsible for getting the patient to sign a consent FOR THE MED WE'VE ALREADY GIVEN when they have calmed down enough. I have never heard of getting a consent after the fact. I know if I were a patient I wouldn't sign! Is this legal? Management just says that the state surveyors expect to see a consent for every med given and if we can't get the consent before, we need to get it afterward.

[Davey Do]

maxthecat:

You have a valid concern here: gettting a consent for an emergency forced medication that was administered for a therapeutic purpose. However, the patient is incapable of recognizing that purpose and refuses to give consent.

I can only speak off the top of my head and give you my perspective from my experiences.

First, I have to question the management's understanding of the process. A speaker in one particular seminar that I attended said that, often times, managing bodies often OVERINTERPRET policies. Or, interpret policies from a parochial perspective.

For example, in the facility where I work, we too, have to have completed and signed psychotropic medication consent/counselling forms before the medication is administered.

However, in the event of a forced medication for example, psychosis (we don't document "agitation"), we have a legal process that partially entails a State generated form entitled "Notice Regarding Restricted Rights of Individual". It has a box for "emergency forced medication" and a line for a narratative reason. An example would be "aggression and self-harm".

In other cases, there is a Physician Order Sheet for Forced Medication. These forms are only good for 24 hours, so the Psychiatrist must complete one every day if the medicine is to be continued.

Another case of forced medications can be ruled on by a judge.

Perhaps I'm going into more detail than what you require. As far as getting the consent after the fact, I guess for superfluous purposes of formality, that works.

Sometimes we just have to do what we have to do.

Good luck to you, maxtheact.

[maxthecat]

Thanks, Davey Do. I appreciate your examples and explanations. Your process makes a lot more sense to me than ours does.