EMERGENCY PSYCHIATRY - MEDICAL COMPETENCY THE PSYCHIATRIC CONSULTATION

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EMERGENCY PSYCHIATRY- MEDICAL COMPETENCYTHE
PSYCHIATRIC CONSULTATION
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EMERGENCY PSYCHIATRYSTANDARD OF CARE

• ALWAYS SAME STANDARD
• LAW ACKNOWLEDGES
• EMERGENT CIRCUMSTANCES
• REQUIRES REASONABLE EFFORTS
• NEED TO ACT BEFORE ALL FACTS IN
• RISK KNOWN REQUIRES PLAN
• PLAN REQUIRES ACTION

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DECISIONS

• IS PATIENT PSYCHIATRIC?
• WHAT DO YOU NEED TO KNOW?
• WHO KNOWS IT?
• DOES PATIENT NEED HOSPITALIZATION?
• VOLUNTARY OR INVOLUNTARY?
• IF YOU DECIDE NOT TO ADMIT
• DOES PATIENT HAVE COMMUNITY SUPPORT?
• WILL PATIENT BE SAFE UNTIL FOLLOW-UP?
• DO YOU HAVE REPORTING DUTY?

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CHARTING

• CHART LESSER INTERVENTION MORE THAN GREATER ONE
• DO YOU NOW 6-OCLOCK NEWS RULE
• LAW SAYS NOT CHARTED, NOT DONE
• ALWAYS COMMENT ON COMPETENCY
• TIME YOUR NOTE

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MEDICAL COMPETENCYPSYCHIATRIC CONSULTATION

• COMPETENCY PRESUMED IN EMERGENCY
• IF NOT EMERGENCY, ESTABLISHED CUSTOM?
• LPS DOES NOT AUTHORIZE MEDICAL RX
• A PATIENT REFUSAL IS INCOMPETENT IF
• 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

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THE PSYCHIATRIC CONSULTATION

• IF REFUSING, PT MUST BE TOLD ALL RISKS
• DO GOOD MSE (PROBATE 811)
• DETERMINE FOLLOWING
• 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.

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SHC ETHICS POLICY GUIDELINES INFORMED CONSENT
WHEN ADULT PATIENT LACKS CAPACITY

• IF PATIENT HAS APPOINTED SURROGATE
• IF PATIENT HAS NO APPOINTED SURROGATE