Project Details
About the Project
When older adults with delirium or confusion present at emergency, it can be hard to provide the correct care to them quickly. To be able to keep them in hospital while doing an appropriate assessment, two pieces of legislation exist that enable emergency physicians and other care team members to ensure excellent, appropriate care. But which to use and how to use it?
As Geriatric Psychiatrists, Dr. Jeanine Marshall, Dr. Crystal Zhou, and Dr. Emilie Langis are well-versed in the Mental Health Act (MHA) and the Health Care (Consent) and Care Facility (Admission) Act (HCCCFAA). They have seen that the MHA is well-resourced and well-understood in the hospital, complete with the paperwork and administrative guidance that staff can refer to when providing care to these vulnerable patients. As shared by Dr. Marshall, resources for the MHA exist so that “team members feel comfortable to ensure that patients stay.”
That same sort of comfort doesn’t yet exist with the HCCCFAA: There is no document to refer to or use when it is decided that a patient is incapable that identifies the substitute decision makers and highlights who gives substitute consent. The Geriatric Psychiatrists saw an opportunity to create a standardized document to be used when the decision has been made to keep a patient in hospital under the HCCCFAA; provide workshops for physicians to review the use of the HCCCFAA and introduce the document; as well as work with Island Health to offer education sessions for Clinical Nurse leaders, Clinical Nurse Educators, Protection Services Officers, Nurses, and Social Workers.
Drs. Zhou and Langis developed a prototype document and requested it be reviewed by Island Health: They wanted to make sure their work was developed with legal limitations in mind. Unfortunately, they came up against roadblocks with both Island Health’s Legal and Risk Management departments, and weren’t able to move forward with this project. With changes to support services on the provincial front as well as pioneering work on HCCCFAA implementation in other health authorities, it is hoped that a standard of practice will be developed elsewhere that can be implemented at Island Health.
In the meantime, the teams in Emergency Medicine and Geriatric Psychiatry will continue to provide excellent, thoughtful care to elderly patients who seek their clinical help.