Taking consent

موضوع: Taking consent الأربعاء نوفمبر 23, 2011 12:10 pm

Taking consent

...

Introduction

In order to practise in a professionally responsible manner, a dental practitioner must

assist patients to make well-informed decisions about treatment procedures. Consent

may be of three types; implied, verbal or written. For consent to be obtained the patient

must have:

1. Capacity to consent

2. Understand the implications of treatment including:

a. material risk

b. time, extent and frequency

c. outcome

d. possible complications

e. cost

3. Understand alternative treatment options, including undertaking no treatment

4. Given the consent freely, not under duress

Written consent (the patient’s signature on a document) does not of itself establish that

consent has been obtained. Among the matters, which would be considered by a court

of law to establish consent, are:

 the patient was given sufficient and appropriate information on all aspects of the

procedure

 the information was provided in such a form that the patient could fully understand it

 the patient, before consenting, had sufficient time to deliberate in an unfettered way

on the relevant information

 all possible complications, their frequency, the degree of incapacity they may cause

and the possibility of permanence, were fully outlined in a way that the patient could

completely understand

 the cost of treatment was fully outlined and understood

 the patient’s expectations of treatment outcomes were realistic

 an appropriate referral was offered

 an appropriate diagnosis was established

 an accurate medical history was established and appropriately accounted for in treatment

Capacity to Consent

People may be considered not to have the capacity if they are:

1. Minors (<16 years)

2. Mentally ill

3. Intellectually impaired

4. Affected by drugs or alcohol rendering them incapacitated.

In the case of minors or other persons with a legal disability the consent of the parent,

guardian, or adult guardian1 should be obtained.

Clinical Consent

Every patient should have a treatment plan for each course of care recorded in his or

her record in the Patient Management System. In the case of students this must be

authorised by a clinical supervisor. The plan should be discussed with the patient or

their guardian and the discussion documented in the clinical notes. A print out of the

treatment plan should be provided to the patient:

1. On request by the patient

2. The treatment is complex involving numbers of appointments

3. The treatment involves partial dentures, crown and bridge work, implants, molar

endodontics, or surgery

Verbal consent is acceptable for simple general dental care and should be

documented in the records.

Written consent should be obtained for more complex treatment as described at item 3

above by asking the patient to sign a copy of the print out of the treatment plan. In

addition all minors and cases of adult guardianship require written consent (see section

on guardianship).

The National Health and Medical Research Council (NHMRC) in 1993 produced a set of

guidelines on providing information to patients and recommends that practitioners

discuss:

1. The possible or likely nature of the care

2. The proposed approach to treatment including:

a. numbers and length of appointments

b. possible referrals to other practitioners or specialists

3. Other options for treatment

4. The likely outcomes

5. Any possible complications

6. The likely outcome of have no treatment

7. Cost (see section on financial consent)

Financial Consent

Patients or their guardians should be informed prior to their next

appointment of the likely costs.

Any treatment plan for which the cost is likely to be more than $500.00 should be

referred to any clinical support staff member who will:

1. Discuss and/or develop a payment plan.

2. Provide the patient or guardian with a written copy of the costs and

3. Obtain written consent by way of a signature

Guardianship

Minors Verbal/implied consent is acceptable for examination, radiographs, prophylaxis

and simple treatment with the parent present. Written consent should be obtained for all

procedures for patients under 16 years of age from the parent or guardian if they are

not going to be present.

Occasionally, a parent delegates their responsibility for consenting to treatment on

behalf of their minor child to another adult. This may occur for example, in relation to

Aboriginal children, where an extended family member is responsible or where both

parents work and another provides daily care for the minor. Ideally, this delegation

should be in writing and a copy should be scanned into the patient’s record.

Adult Guardianship (Mental and Intellectual Impairment) Where adults are incapable of

providing consent the Guardianship and Administration Act 2000 outlines the substitute

decision making process:

 If possible follow an advance Health Directive (“AHD”)

 If there is no AHD, follow the direction of a guardian appointed by the Guardianship

and Administration Tribunal (“The Tribunal”) or any order of The Tribunal

 If the Tribunal has not made a ruling obtain consent from an attorney appointed

under an Enduring Power of Attorney

 If there is no appointed attorney obtain consent from the statutory health attorney

 If there is no readily available, culturally appropriate statutory health attorney,

contact the Adult Guardian who may provide consent as the decision-maker of last

resort.

Clinical Research

This process will require the approval of written

information for the patient and written consent forms. Researchers must ensure:

1. Patients are provided with approved information.

2. The information and nature of the project is explained to them

3. All discussions are documented in the clinical notes

4. The approved consent is signed and scanned into the patients file

...

From [ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذا الرابط]

موضوع: رد: Taking consent الأربعاء نوفمبر 23, 2011 10:36 pm

thanx dear

موضوع: رد: Taking consent الثلاثاء نوفمبر 29, 2011 1:18 pm

You're welcome my dear :)

موضوع: رد: Taking consent الثلاثاء نوفمبر 29, 2011 7:56 pm

موضوع: رد: Taking consent الخميس يونيو 14, 2012 9:04 am

dr_mohammed كتب:

you're welcome