Non-compliant pt. protocol?

[jvencius]

Does anyone have written protocols re: Duty-to-treat for noncompliant patients that you could send me? I'm working on a paper for my Medical Ethics class and need some outside references but all that I've found online haven't been useful. PM for my email address if you can help--thanks in advance.

[afff_667]

Non-compliant? Strictly speaking, I think if a patient is an adult and sufficiently A&O, according to protocol standards, to refuse treatment (all or part), then that answers that. The patient has the right to refuse treatment. You could try and talk them into treatment or wait until they deteriorate such that implied consent exists.

If the patient is in legal custody for whatever reason, then established protocol should/may address that. That would be up to the medical director, lawyers, etc.

If a patient is not sufficiently A&O, then I'd assume that implied consent exists to cover proceeding with treatment until such a time that the patient becomes sufficiently A&O to refuse all or part of treatment.

Maybe I misunderstood what you're looking for, though. In my old system, written protocols established those points.

ETA: I'm sure I misinterpreted what you are asking, so please disregard.

[NinjaMedic]

Like afff I am a little unclear on what you are referring to. It basically comes down to whether the patient has present mental capacity, if they do and they don't want to "comply" then that is their right right as an adult to refuse care.

If you are asking about restraining combative or violent patients who do not have present mental capacity I can send you our restraint/sedation patient care guideline. Basically soft restraints for all extremities and if needed a healthy dose of a benzodiazepine (usually Versed) or anti-phsychotic like Haldol.

[motorwerks]

Take a look at 2101.12, 2102.06, and 8051.07 this is my current Sacramento County Policies, Procedures and Protocols

http://www.sacdhhs.com/article.asp?ContentID=1122

[ncrebel8]

Afff pretty much gave a good run down of all the legal tretment options in his reply. You have asked a very open question. If there is something more specific you want to know about, maybe we can help.

[citizensoldier16]

Here's a link to the my protocols. Check out "refusals" and "restraints" under the Procedures section. If you scroll to the index at the front you can click on each protocol and it'll take you to it....no scrolling down forever. Oh, and you can also look at "Police Custody" under the General section. Hope this helps.

http://www.co.orange.nc.us/emergency/documents/2009EMSProtocols.pdf

[LUCKY MEDIC25]

Join the military... lol If we feel we need to give a soldier care, he/she is getting that care! Even if they need to be restrained.

[Frankyoz]

As the other guys stated if a PT is AOx4 they have every right to refuse care and transport. The only time I have encountered when this is not true is if the PT has a court ordered medical treatment plan. In those cases we call PD they come down and we give them a chance to comply. If they do not PD takes them into custody we treat them or transport them to a facility that makes them comply then PD chooses wether they are to be held or released. However if your talking about a PT that is altered or not capapble of making sound decisions it comes into an ethical stand point of the treating health care proffesional to step in and be a patient advocate and do what is in the patients best interest. Even if that means sedation and transport to a nearby hospital or legal facility whatever is in their legal scope of practice and will be dictated by their medical control and protocols.

[fdawg]

In Washington State we have something called involuntary commit. basically, If a police officer is willing to fill out the form we can take anybody by force if needed. so with this "tool", the police usually just tell a patient either you go with these guys, or I will force you to go anyway and you will have this in your records... In fact, I have been to family disputes where somebody states that the other wants to hurt themselves and boom they must go to the hospital. This presents a problem for a paramedic when the person is AO4 and GCS 4/5/6 And states, F U, I ain't goin!