Combined management and MRPJanuary 15, 2018
Who is the Most Responsible Physician (MRP)?January 22, 2018
Informed Consent — agreement or permission accompanied by full information on the nature, risks, and alternatives of a medical procedure or treatment.
Comgetent Individual – A person who is mentally capable of understanding the nature of the procedure and associated risks who has reached the age of consent.
Sterilization – permanent method of contraception.
M.T.P. – Medical Termination of Pregnancy
- Informed consent is obtained before surgery, anesthesia, procedural sedation, use of blood and blood products and other high risk treatments and procedures.
- Consent must be taken by explaining to the patient/ family the following:
- Nature of the treatment or procedure
- Expected benefits, complications and risks
- Alternative courses of action
- Consequences of not undergoing the treatment or procedure
- Any procedure or treatment that, in the judgment represents a potential medico-legal risk should complete an informed consent.
- Exclusion: The following circumstances, only in the ER, do not require informed consent for procedural moderate sedation/ analgesia or procedure (but not limited to):
- Majorjoint dislocations or fracture dislocations.
- Displaced extremity fractures with severe angulations.
- Any fracture with evidence of distal vascular compromise.
- Major burns requiring immediate management and debridement 2″°’ degree and above
- Cardioversion for unstable dysrhthmias resulting in end-organ compromise.
- Emergency insertion of:
- Central venous catheters
- Chest decompression needles or drainage devices
- Pericardiocentesis needle drainage
- Diagnostic peritoneal lavage catheters in the setting of trauma
- Any necessary invasive procedure that is urgently required in a patient whose judgment seriously impaired by substances and where treatment delay could potentially result in significant patient harm.
- All consent forms must be written in English and Arabic if patient’s first language is Arabic.
- Any competent individuals may sign his/ her own consent form.
- An adult female (i.e., has reached the legal age of 18 years) is legally responsible for herself and may consent to treatment (subject to local custom).
- Minors (patient who are under the age of 18 years) or a person not physically or mentally fit to give consent will be exercised through their parents or other representative.
- Minors who are not accompanied by their parent(s), spouse, closest adult male relative or other appropriate legal guardian:
- Shall not be treated if they presented with non-emergent conditions to the clinic or ER and inform Social Worker and the patient’s closest male relative or sponsor.
- Shall receive treatment without delay in ER for life or limb-threatening through emergent conditions while efforts are made to contact the patient’s closest male relative or sponsor.
- Nursing Service Dept. personnel sign as a witness on consent forms, acknowledging they have witnessed the signing, not the explanation of the procedure (informed consent).
- A second witness of consent can either be relative, friend, and attending doctor or sponsor if attending with the patient.
- Duration of (all) informed consent forms:
- From the date a consent form is signed by the patient/ patient’s representative, it is “valid”:
- For single procedures — maximum of 15 days
- For repeating a single procedure — either for the number of procedures of the time period specified on the consent form (as part of the physician’s speciﬁc treatment regimen).
- Consent must be reobtained and redocumented:
- If more than 15 days lapse between the date the patient/ patient’s representative signs the consent form and when the procedure is performed (for a single procedure).
- If the condition of a patient admitted for a specific treatment or procedure subsequently changes significantly.
- If a different procedure is required.
- For medical termination of pregnancy, patient and husband will sign two (2) forms: informed for medical termination of pregnancy, patient and husband will sign two (2) forms: informed consent and “Justification for MTP Counseling & Consent” form in English or Arabic.
- in case of emergency where surgery, anaesthesia, use of blood and blood products, and other high-risk treatments is needed and the patient is unable to give consent and no relative or guardian or sponsor is available, the following will be followed:
- The attending physician must secure the agreement of another qualified physician after consultation that it is imperative to perform the procedure without delay.
- The attending physician and consulted physician will record in the patient’s file after agreement that the surgery is absolutely necessary without delay and signed by both physicians.
- Any patient who refuses treatment or surgery, anaesthesia, use of blood and blood products, and other high-risk treatments deemed necessary by the treating clinician or who discharges him/herself from hospital will sign ”RELEASE FROM LIABILITY” form. As stated in “Refusal of admission, leaving against medical advice (LAMA) and/ or refusal to accept medical/ dental care” This form may be signed by inpatients, outpatients and Emergency Room patients.