Accreditation

Q&A: Patient involvement and representatives

Briefings on Accreditation and Quality, February 1, 2018

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Briefings on Accreditation and Quality.

Both a medical necessity and a compliance requirement

Involving patients in their care isn’t just polite, it’s a CMS requirement. Condition of Participation (CoP) §482.13(b)(2) says that patients have the right to make informed choices about their care and be involved in crafting their care plan. And CoP §482.13(a)(1) requires hospitals to take reasonable steps to decide who the patient’s designated surrogate is when the patient is unable to make the decision.

So what’s the best way to keep patients informed about their care? What documentation does CMS require to show it was done? Can a hospital ever override a patient’s decision? And how do you determine who the patient’s representative is if the patient is unconscious or incapable of making that choice?

We asked these and other questions of three patient safety coaches at Studer Group: Diana Topjian, Thomas Dahlborg, and Erin Shipley, RN, MSN.

Q: What’s a good rule of thumb for determining what information patients need to know to make an informed decision about their care?

Diana Topjian: I don’t know that there is a “rule of thumb,” per se. However, from an informed consent perspective, it must be clear that the patient understands the risks and benefits of both agreeing or declining to the treatment regimen.

I would suggest that the patient truly needs to know all that is involved in how the provider decided upon a certain treatment to make a fully informed decision.

It’s incumbent upon us as providers to ensure we present the plan of care in such a way that the patient (and/or family) understand and clearly can follow the information we used in reaching those decisions.

Thomas Dahlborg: It’s essential the patient and the family is involved in cocreating the care pathway.
However, sometimes the family is a contributing factor to adverse mental, physical, emotional, or spiritual health. Often we default (with good intention) to a place of “engage the family.” More important is to understand the family and the dynamic and then strategically engage to best meet the patient’s needs.
Only with the patient (and again family when appropriate) actively engaged in the decision-making will key nuggets of wisdom be uncovered.

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Briefings on Accreditation and Quality.

Most Popular