Patient Consent to Treatment

KateRN1 · Mar 23, 2012

I agree with the more conservative approach. Treatment and assessment are two separate issues. Your initial contact with the patient is to determine if s/he is appropriate for home care services. I know that not all consents are the same but with ours, we have to complete a nursing frequency, indicate the payer source (generally Medicare or Tricare) and health care insurance number, and have the patient sign. All of that pretty much indicates that the patient is ours for service. We do not have the patient sign the consent for treatment until and unless the patient is determined appropriate for home care.

AMN74 · Mar 24, 2012

I generally do not do admission visits at our agency, as we have Start of Care nurses. However, sometimes they are overbooked and we are either asked to do first visits which include getting a consent form signed or do the start of care. I saw an elderly female patient a few weeks ago and it was to be a start of care visit. I asked her to sign a consent form and she said her son was on his way he had gotten tied up at his office, and that I could go ahead with the visit and he would be there soon and we could sign forms. I assessed her, reviewed meds, and was entering them in the computer when he arrived. I continued with with my visit and did teaching and gave her a b12 injection, did the oasis and got back to the consent form. I gave the son a copy and he read it over as I described the form and it's purpose. The son finally looked at me and said that he was an attorney and could not allow his mother to sign the form. He was not comfortable with how it was worded. I had him mark out the part of the form with a huge x that he was not comfortable with, and sign the part that said I had permission to treat her. He was not happy, I was not happy and the patient was confused. I'm just telling you this instance to tell you to always get the consent form signed first! You never know what you are going to run into out there and if you don't have written permission to treat the patient it could be considered "battery" if you give and injection without prior consent. My supervisor finally got the patient son on the phone and discussed the form and I think the agency agreed to admit her after he sent a signed consent form to our agency, but you can't just assume because you walk through the door that the patient is giving you permission to treat. It does not work that way!

KateRN1 · Mar 28, 2012

Consent to assess is not the same as consent to treat. No way would I have done anything other than assess without a signed consent form.

What if you had the consent signed first, but after you evaluated the patient determined that she was not a good candidate for home care? Now you have a patient to whom you are legally obligated.

caliotter3 · Mar 28, 2012

I have met some people who would be eager to take advantage of a situation where an administrative mistake had been made, so that they could gain something from the fact. You can practically smell the legal advisors in the wings and the flutter of money. Better to do things correctly from the beginning, than to have to rely upon another person "understanding" the need to "fix things".

jennys3 · Apr 3, 2012

I perform many SOCs for my agency but a couple weeks ago refused one as the patient was confused with a diagnosis of alzheimers and the POA/conservator could not be at the admission to sign the paperwork. I just got a voicemail from out Director of Homecare explaining to me that I should have gone ahead with the SOC anyway and just had our intake dept fax copy of the paperwork after the admission. The admit was on the weekend and this paperwork would not be faxed for at least 24 hrs. What do you think? Should I have done the SOC?

AMN74 · Apr 3, 2012

Jennys3,

Was the patient deemed incompetent then he would need POA present to have paperwork signed for him. If he is not legally deemed incompetent, then technically you should have him sign consent papers admit, and leave a copy of the signed paperwork with the patient for the POA to look over and call for any questions. Many people, including myself, have designated a POA, in case something happens to me and I can not make decisions for myself, I have spelled out what I wish to be done on a Living Will form, and I have discussed with my POA at length about what my wishes are and what I would not want done to my body if I could not make decisions for myself. But that does not mean I am incompetent and that I would need my POA to sign a consent to treat form for me at this moment. Dementia and Alzheimer's are tricky diagnosis-es. It really depends on if they have been deemed incompetent in order to make the judgement call about them signing the paperwork. In fact, if they are legally competent then they should sign the paperwork regardless of who is POA. In the eyes of the law I believe that they still have the legal right to make decisions for themselves. Our consent forms have a place for patient signature and then a spot for "other signature" and if you use "other" you must specify why someone other than the patient signed the form. I once had an illiterate man ask me to have his son sign the form for him. He said he could write his name, but he preferred his son sign the form. When we got a survey from CMS they said I should ALWAYS have the patient sign the form unless they were incompetent or sometimes blind and can't see to sign, they said I should have read the entire form to the patient and had him sign himself since he was legally competent...So I learned a lesson that day.