It was identified that some patients with a legal guardian or a Durable Power of Attorney for Health Care (DPOA-HC) were signing their own consents for treatment as well as consents for procedures and code status.
Also identified were emergency contacts listed on patient face sheets did not consistently reflect the name of the legal guardian or DPOA-HC.
It was then concluded that a new process was needed for determining and identifying patients with legal guardians and active DPOA-HC.
According to the courts, a person who has a legal guardian has been deemed to a Legally Incapacitated Person (LIP). The guardian is a person "“ a relative, friend or professional "“ appointed by the probate court and given power and responsibility to make certain decisions about that person's care.
DPOA-HC, however, has been chosen by the patient prior to incapacitation "“ a legal mechanism allowing the designee to make health care decisions for the patient when he or she becomes unable.
Both require signed documentation. (Guardianship requires letters of guardianship signed by a judge. DPOA-HC requires a signed form that can vary, with some requiring a notary signature and the signature of the person accepting the DPOA-HC responsibility.)
The revised process will include:
Admitting and registration staff are educated on triggers that indicate a patient may have a legal guardian and are provided with tools to verify legal guardianship online. Case managers were also education on how to verify legal guardian status
If the legal guardian or DPOA-HC is not present at the time of admitting, the admitting clerk will contact that representative via phone.
Requests will be made for a copy of the Letter of Guardianship or DPOA-HC to be faxed to admitting and will be attached to charts to be later be scanned into the EMR by the Medical Records department.
Legal Guardian or DPOA-HC will be listed as Next of Kin (NOK) on the patient face sheet
Patient alert in Paragon will be flagged as NOK change.
Patient will be given a blue wristband to alert clinical staff that patient has legal guardian or active DPOA-HC who will be giving and signing all consents for treatment, procedures, DNRs, etc.
Informed Consent Policy 1-113 will be updated to reflect changes in process.
If Legal Guardianship or DPOA-HC is missed at time of registration and face sheet changes and/or a blue wristband is needed, staff should contact the admitting department.
Questions regarding Legal Guardianship or DPOA-HC can be directed to the Clinical Social Work Department.
Questions regarding registration process and blue wristbands can be directed to Denise Cardoso at (586) 493-3529.