Transcript EMERGENCY PSYCIATRY - Stanford University

EMERGENCY PSYCHIATRY
MEDICAL COMPETENCY
THE PSYCHIATRIC CONSULTATION
EMERGENCY PSYCHIATRY
STANDARD OF CARE
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ALWAYS SAME STANDARD
LAW ACKNOWLEDGES:
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EMERGENT CIRCUMSTANCES
REQUIRES REASONABLE EFFORTS
NEED TO ACT BEFORE ALL FACTS IN
RISK KNOWN REQUIRES PLAN
PLAN REQUIRES ACTION
DECISIONS
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IS PATIENT PSYCHIATRIC?
WHAT DO YOU NEED TO KNOW?
WHO KNOWS IT?
DOES PATIENT NEED HOSPITALIZATION?
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IF YOU DECIDE NOT TO ADMIT:
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VOLUNTARY OR INVOLUNTARY?
DOES PATIENT HAVE COMMUNITY SUPPORT?
WILL PATIENT BE SAFE UNTIL FOLLOW-UP?
DO YOU HAVE REPORTING DUTY?
CHARTING
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CHART LESSER INTERVENTION MORE
THAN GREATER ONE
DO YOU NOW 6-O’CLOCK NEWS RULE
LAW SAYS NOT CHARTED, NOT DONE
ALWAYS COMMENT ON COMPETENCY
TIME YOUR NOTE
MEDICAL COMPETENCY
PSYCHIATRIC CONSULTATION
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COMPETENCY PRESUMED IN EMERGENCY
IF NOT EMERGENCY, “ESTABLISHED CUSTOM”?
LPS DOES NOT AUTHORIZE MEDICAL RX
A PATIENT REFUSAL IS INCOMPETENT IF:
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UNABLE TO RESPOND KNOWINGLY AND
INTELLIGENTLY TO QUESTIONS ABOUT RX
UNABLE TO PARTICIPATE IN TREATMENT DECISIONS
USING RATIONAL PROCESSES
UNABLE TO UNDERSTAND INFORMATION ABOUT
THE RECOMMENDED TREATMENT
THE PSYCHIATRIC CONSULTATION
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IF REFUSING, PT MUST BE TOLD ALL RISKS
DO GOOD MSE (PROBATE 811)
DETERMINE FOLLOWING:
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DID PATIENT COMMUNICATE DECISION?
WAS DECISION BASED ON CONSENT INFORMATION?
IS THERE MENTAL STATUS DEFECT?
DOES THE DEFECT EXPLAIN THE REFUSAL?
WRITE NOTE SUFFICIENT FOR PETITIION
IF INCOMPETENT, BURDEN ON PCP TO ACT.
SHC ETHICS POLICY GUIDELINES
INFORMED CONSENT WHEN ADULT
PATIENT LACKS CAPACITY
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IF PATIENT HAS APPOINTED SURROGATE
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IF PATIENT HAS NO APPOINTED SURROGATE