DISPOSITION OF PATIENTS REFUSING TREATMENT
PREPARATION:
MOTIVATION: To ensure technicians are acting in the best interest of the patient and to reduce the number of potential lawsuits against the agency and the technicians.
OBJECTIVE (SPO):
1. Given a patient scenario, the student shall describe the steps required to acquire information needed to perform an ample refusal interview that fulfills the N.O.T.O.S. method
Enabling Objectives
1-1-1 The technician will describe factors that affect patient interviews
1-1-2 The technician shall describe gathering information from scene survey
1-1-3 The technician will describe gathering information from subjective sources
1-1-4 The technician will describe gathering information from objective sources
2. Given information included in (S.O.A.) of an appropriate S.O.A.P.E. note, the technician shall describe the steps of conducting a refusal interview required to fulfill the N.O.T.O.S. method.
Enabling Objectives
1-2-1 The technician will describe notifying a patient of the situation and possible outcomes if when
refusing treatment.
1-2-2 The technician will describe to a patient treatment per protocols and training and possible
outcomes of treatment.
1-2-3 The technician will describe repeating possible outcomes to patients refusing treatment
1-2-4 The technician will describe reading and explaining a refusal statement to a patient
3. Given the components of a refusal interview, the technician will be able to document a patient using the N.O.T.O.S method.
Enabling Objectives
1-3-1 The technician will describe how refusals are signed
1-3-2 The technician will document a patient’s wishes to refuse
1-3-3 The technician will document on health issues and possible outcomes on patients refusing
treatment
1-3-4 The technician will document on treatment told to the patient and possible outcomes
1-3-5 The technician will document the signing of a refusal
OVERVIEW: DISPOSITION OF PATIENTS REFUSING TREATMENT
* Factors that affect interviews
* Gathering information from scene survey
* Gathering information from subjective source
* Gathering information from objective sources
* Notify patient of situation and possible outcomes to patient
* Describing treatment per protocols and training and possible outcomes
* Repeating possible outcomes to patients refusing treatment
* Describing reading and explaining a refusal to the patient
* Describing how refusals are signed
* Documenting how refusals are signed
* Documenting a patient’s wish to refuse
* Documenting on notification of health issues and possible outcomes on patient’s refusing treatment
* Documenting on treatment told to the patient and possible outcome
* Documenting the signing of a refusal
I. GATHERING INFORMATION
A. Factors that affect interviews
1. Personal appearance
2. Attitude
3. Language
B. Gathering information from scene survey
1. Safety
2. Environment
3. Bystanders
C. Gathering information from subjective sources
1. Bystanders
2. Public safety officers
3. Patient
D. Gathering information from objective sources
1. Physical exam
2. Scene
II. CONDUCTING A REFUSAL INTERVIEW
A. Notifying patient of situation and possible outcomes to patient
1. Tell patient situation
2. Tell patient possible health outcomes
B. Describing treatment per protocols and training and possible outcomes
1. Tell patient of planned treatment
2. Tell patient possible outcomes
C. Repeating possible outcomes to patients refusing treatments
1. Give possible outcomes
2. Give possible choice of treatments
D. Reading and explaining refusals
1. Read refusal to the patient
2. Explain the refusal
3. Witness
III. DOCUMENTATION OF PATIENT REFUSAL
A. How refusals are signed
1. Patient signs refusal
2. Witness records / relationship
3. Witness signs refusal
B. Documenting a patients wish to refuse
1. Record wish to refuse
2. Record reason why, if given
3. Record patients plan, if any
C. Documenting on health issues and possible outcomes on patients refusing treatment.
1. Record that patient was advised of information.
2. Record health outcomes told to patient.
D. Documentation of treatments explained to the patient
1. Record treatment modalities told to the patient
2. Record possible health outcomes told to patient
E. Documentation of the signing of a refusal.
1. Record the patient’s desire.
2. Record that the patient read and was given verbal explanation of the refusal.
3. Record the name and relationship of witnesses.
REVIEW:
DISPOSITION OF PATIENTS REFUSING TREATMENT
* Factors that affect interviews
* Gathering information from scene survey
* Gathering information from subjective source
* Gathering information from objective sources
* Notify patient of situation and possible outcomes to patient
* Describing treatment per protocols and training and possible outcomes
* Repeating possible outcomes to patients refusing treatment
* Describing reading and explaining a refusal to the patient
* Describing how refusals are signed
* Documenting how refusals are signed
* Documenting a patient’s wish to refuse
* Documenting on notification of health issues and possible outcomes on patient’s refusing treatment
* Documenting on treatment told to the patient and possible outcome
* Documenting the signing of a refusal
EVALUATION: See Scenarios
SCENARIO Work Sheet:
You respond to an office building to assist a 26-year-old male who had a syncope episode. Bystanders say the patient was telling a joke while he organizing and filing papers. The patient accidentally stapled his thumb. After pulling the staple out, the patient lost consciousness. The patient is currently alert with minimal bleeding from his thumb. He appears embarrassed and refusing treatment.
Scene Survey: a.
b.
c.
d.
e.
Objective: a.
b.
c.
d.
e.
Objective: a.
b.
c.
d.
e.
_____________________________________________________________
N.O.T.O.S.
N – Notification of Situation
O - Possible Outcome:
T - Told Treatment Modalities:
O - Possible Outcome with treatment / Repeat possible outcome without treatment
S - Signing Refusal
DOCUMENT REFUSAL USING N.O.T.O.S. SYSTEM
SCENARIO Work Sheet:
You respond to a MVA. The patient is the driver of a low-impact incident. There is no visible damage to the front of her vehicle. The 45-year-old female states passing out while at a stoplight. She experienced “pain in her right ear then that was it.” The patient has a history of diabetes. Bystanders were able to awaken the patient after they pulled her from her car and laid her under a tree following the accident. The patient currently feels a little dizzy. She took her own blood sugar and it registered at 125mg/dl. She states feeling better. Refusing Treatment.
Scene Survey: a.
b.
c.
d.
e.
Subjective: a.
b.
c.
d.
e.
Objective a.
b.
c.
d.
N.O.T.O.S
N - Notified of Situation
O - Possible Outcome
T - Told Treatment Modalities
O - Possible Outcome with treatment / Repeat possible outcome without treatment
S - Signing Refusal
D0CUMENT REFUSAL USING N.O.T.O.S. SYSTEM
