Specifically in Psychiatry informed consent is a major concern for patient safety and care. Before each patient is given a psychotropic medication, the doctor must first explain what medication the patient will be taking for their specific disorder and what symptom they are targeting. For example the doctors must explain to the patient all psychotropic medications that the patient will be taking; Risperdal for psychosis and delusional thought content, Ativan for anxiety or agitation. The patient is also informed of side effects, and that they may or may not get better from the medication. Both patients and doctor sign the consent form which then becomes part of the medical record. Before a nurse can give a psychotropic medication, the consent form must be signed. When emergent medications are needed secondary to patient agitation, direct threats, bodily harm to self or others then the consent is waived for the safety of both staff and patients. However, IM medications are only given for emergent medication needs and the safety of the unit. Patients do have the right to refuse any and all medications in the psychiatric unit including medical medications and procedures. When patients refuse to sign the Psychotropic Medication Consent Form or agrees to take the medication but may refuse to sign the form, then a witness must also sign the form along with the doctor’s signature. If the patient refuses any or all of their psychotropic medications as is their right, a Riese hearing can be applied for by the doctor to force a patient to take medications against their will. This is a court hearing with the doctor, judge, patient and patient advocate (attorney for patient). Each side states why the patient should or should not be forced to take medication against their will. If the finding is that the patient will benefit from the medications more than be hurt from the medications, then the psychotropic medication can be given against the patients will usually with IM medication. Patients are always offered PO medications first, however, if they refuse then the medication will be given IM against their will. As is the law in California, all medications that could possibly be given to the patient must appear on the Riese form. Patients have the right to refuse medication if they are voluntary or involuntary (placed on a legal hold for observation). The only time patients do not have a legal right to refuse psychotropic medications is if they have lost their Riese or if they are on a Permanent Conservatorship and that person’s Conservator then has the right on behalf of the patient to make psychiatric decisions for the patient. I believe that California law covers informed consent and the right for least restrictive treatment and environment for psychiatric patients.
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