Legal ethical mental health safety PDF

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Description

Legal/ethical mental health safety HIPAA variations ● A personal representative is a person who is authorized (under State or other applicable law, e.g., tribal or military law) to act on behalf of the client in making health care related decisions when the client is incapable/ incompetent to make concious decisions. In addition to making decisions on behalf of the client, the personal representative may also authorize disclosures of the client’s protected health information. a. Only applies to health care decisions i. Who can be the personal representative? A health care power of attorney, court appointed legal guardian, general power of attorney, or durable power of attorney that includes the power to make health care decisions.

Can have privileges revoked in cases of suspected abuse, neglect, and endangerment Confidentiality and Disclosurea. The patient–physician relationship is bound by the moral and ethical sanctity of confidentiality, more so in mental health. This is one of the fundamental responsibilities of the psychiatrist. b. Providers may disclose in the event that the client may present as a danger to themselves or to others. c. A written informed consent is mandatory in order to obtain permission as to how much can be disclosed and this should be documented in the patient's notes. d. Psychotherapy notes are under special protection, are separate from the client’s medical health records, and require the client’s explicit permission to be disclosed as they typically are not required or useful for treatment, payment, or health care operations purposes. b.

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Release of Information Authorization Form - Must be filled out entirely by the patient. Regarding who information can be provided to and what type of information. - Ranges from assessments/evaluations, treatment records, lab reports, medications being administered, psychological testing, admission, and discharge summary. Clients are also provided a code/pin number by the facility. If friends and family call and request to speak to the patient, healthcare team members are not allowed to provide ANY information at all regarding whether the patient is at the facility. “If the patient is here I will let them know and they can contact you if they choose to do so.”

Baker Act ● Florida Mental Health Act of 1971 ● 72 hour hold in a mental health facility for clients experiencing severe mental illness with a high risk for harm to self or others ● Crisis situations

Restraints (Physical, Chemical, and Seclusion)

● Physical: A physical restraint is any object or device that the individual cannot remove easily which restricts freedom of movement or normal access to one's body. (Example: vest restraints, waist belts, geri-chairs, hand mitts, lap trays, and side rails) Physical restraints can be used for nonviolent, nonself-destructive behaviors or violent-self destructive behaviors. Nonviolent restraints could be used to prevent a patient from pulling out tubes,lines, prevent falls and ensure patient care and safety. Restraints used with Violent self destructive behavior are used with patients who need to be stopped from causing further injury to themselves or others. ● Chemical: A chemical restraint is a form of medical restraint in which a drug is used to restrict the freedom or movement of a patient or in some cases to sedate the patient. If the drug is a standard treatment for the patient’s condition, such as an antipsychotic for a patient with psychosis or a benzodiazepine for a patient with alcohol-withdrawal delirium, and the ordered dosage is appropriate, it’s not considered a chemical restraint. ●

Seclusion Restraint: A patient is held in a room involuntarily and prevented from leaving. Many emergency departments and psychiatric units have a seclusion room or holding room. Typically, medical-surgical units don’t have such a room, so this restraint option isn’t available. Seclusion is used only for patients who are behaving violently. Use of a physical restraint together with seclusion for a patient who’s behaving in a violent or selfdestructive manner requires continuous nursing monitoring.

Any form of restraint requires a doctor’s order and specific documentation. Clients in restraints shall be observed with 2:1 Observation, 1:1 Observation or Continuous Visual Observation (CVO).

Initiating Restraint ●

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Physical and mechanical restraint can only be implemented in emergency situations and the attending physician must be consulted as soon as possible to execute a physician’s order. While in restraints, a person must be observed at least every 15 minutes for injury or problems with breathing. At least once per hour, a nurse must do an observation to check for injuries and to take vital signs. Persons in restraint must be offered the opportunity to drink and to use the toilet and have range of motion, as needed, to promote comfort. Persons in restraint must be clothed appropriately.

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Persons must be informed of the behaviors that caused the restraint and what is necessary for release. The person must be released from restraints after meeting release criteria.

Limitations on Restraint ● ● ● ●

People cannot be restrained in a prone (face-down) position nor can anything be draped across a person’s face. Adults, 18 years of age and older, may be restrained for up to 4 hours but must be released as soon as safely possible. If a person’s behavior continues to be a threat, the doctor can extend the order every 4 hours for a total of 24 hours. If the person continues to meet the criteria for restraint after 24 hours, the physician must physically observe and evaluate the person to determine if the person remains a danger to himself or others. If so, a new physician’s order must be written....