When to have the patient sign consent

[KSU-SN]

I am new to home health, just started 2 1/2 months ago and just last week started doing Start of Cares. I am still on "orientation" if you can call it that because since my second week on the job I have been on my own. Basically I shadowed a nurse for 4 days and then they put me out on my own. I feel like I have no idea what I'm doing...I know the nursing part of it as I worked on a busy med/surg unit for years but home health nursing is SO different.

Anyways, I was doing a start of care a few days ago where about halfway through all of the OASIS interview I had to call 911 and send the man to the hospital. I had done vitals and assessment and everything. I had not gotten the consent for care and treatment signed as I usually do that towards the end when I have gotten a better feel for the patient and how often we should be seeing them, etc because on our consent we also have to fill out our visit frequency and they are signing that they agree to that also. When I went back into the office and they found out I had not gotten the consent signed before doing vitals everyone was upset and really disappointed in me. The nurse educator stated "I told you to always do that first." Well, funny thing is, she went out with me to complete my first Start of Care with me and guess what....we did the consent for care and treatment towards the end. I did not call her out on it though, I just apologized and said I wouldnt let it happen again.

I shadowed 4 nurses and every one of them did the consent last....I truly did not think you had to have a consent to even touch the patient, I thought the consent was for the patient to sign to agree to continue being seen by our homecare company and agreeing to any further orders and to the frequency of visits that we had agreed upon. So my question is....is it really important to have the consent signed before even touching the patient? Could you actually get sued for taking vitals and doing an assessment before getting a consent signed?

[Esme12, ASN, BSN, RN]

I don't do home care however I would think consent should some first.

[nurse42long, RN]

I usually get the paperwork done first. I think it is easier to establish a rapport with the patient and family to ask the non-personal questions first, insurance etc. Also talk about what the agency can do for the patient, pt rights and responsibilites, privacy issues, etc. That's when I get the consent signed. Then I move on to more personal questions and then the physical assessment. If you have to fill out amount and frequency of visits on your consent form, you can always add after the visit and have the patient initial the addition. We don't have that on our consent form. Only consent for treatment, HIPAA policy and release of information to insurance and physician is on consent form. On the paper OASIS we have patient sign the treatment plan which has the Plan of Care, amount of visits planned, if PT, OT or Speech will be added. That is separate from the consent. I don't think anyone is going to sue anyone over getting vital signs before getting a consent signed. The reason your office was upset about not getting the consent signed is that they cannot bill for the services rendered without it. Sounds like you did a good job assessing the patient and getting him emergency care. Pat yourself on the back for that one. :)

[caliotter3]

I would always do that paperwork first, for exactly the rare occasion that you just experienced.

[Libby1987]

If I don't have a set frequency ie vac or I don't know if I will want to add additional services until I've assessed need, I have them sign the consent before any hands on and then fill in the frequency with their participation at the end of the visit and give them their copy. And I explain that to them, that I don't know what they need until I assess but can't assess until they've consented.

I have had to send a few to the er before even getting that far ie I can see they're septic from the door but that's rare.

[anh06005, MSN, APRN, NP]

We still have paper charts at this moment so I go over the patients face sheet (name, DOB, docs, insurance, SSN, pharmacy, allergies, advanced directives) then I ask if they've had HH before and if not explain what we do. Then I tell them "before I can do anything else I need to have you sign a consent. Medicare pays for our services so you shouldn't get any type of bill." (Or something to that effect depending on their insurance). Then I go on with my assessment. Many of our patients we have had in the past so I tell them it's the same consent they signed before (hasn't changed in my 3 years of being there).

But consent should be towards the beginning. I do the little easy questions first to kind of feel them out a little. Not sure how I'd feel someone walking in my door saying "hi. I'm so and so. I need you to sign this consent please."

[toomuchbaloney]

If there is no consent for care your company cannot bill for the time that you just spent in that patient's home or the professional judgement which caused you to contact 911 for him. He just got a free nursing assessment.

Technically speaking, you are not supposed to provide ANY nursing care for the individual until a consent to treat has been signed. In the absence of that a family could give you a difficult go of it should you interact with the patient and something untoward occured which threatened the patient's life or limb. You simply have no evidence that the patient agreed or consented to what you did...and that will matter if the family is pursuing legal remedy for a death or loss.

Be careful out there.

[MaryBlack]

According to the company I recently started with, we can not assess the pt until a consent to treat has been signed.

[DLS_PMHNP, MSN, RN, NP]

Agree with the others. Do your paperwork first and get that out of the way. Sorry you had a bad experience!

[Trisaratops]

I used to work for a home health agency. We got a book to do admissions and give to the client. The first thin. I did with SocS was go over it and get thrm to sign consent. I used to say thst legally I can't touch you until this is signed.

[Benedina]

Paper first. We have consents bound into a book with safety information, contact information, fall risk reduction, all kinds of useful things, so it's very natural to make this the foundation of our first 15 minutes of conversation.

Benedina

[AMN74]

The consent gives the nurse/agency permission to treat the patient. Without permission, you are touching and examining the patient. This is a NO-NO. Patient or Responsible party must always give written consent before you ever lay your hands on a patient or start teaching or anything. You could technically be charged with battery or some silly thing if you are treating a patient without a consent.