Mar 20, 2012, 10:00 am
The patient's rights is determined by CAPACITY. That is if the patient has the cognitive capacity to make a contractual and responsible decision that carry legal ramifications. I.e. If the patient has capacity and hits you, she can be sued. But in dementia, such capacity is not in place and hence they may not be liable for their actions. Hence why you hear about killers getting off on grounds of insanity.
The duty of care for the patient falls on both the care/management and the EPOA (Enduring power of attorney) for the patient. This means that they have to sit down and determine what actions they are to implement for the patient's and the staff's safety. Restrains are seldom used if possible as this cannot be a long term solution. If you look at consents for restrains, they have to be for a specific period of time and must be signed by an assessing doctor.
Like it or not, some form of restrains are used in aged care for safety. Technically a restrain is NOT a restrain if the person so applied with the restrain can easily remove them themselves but this definition applies to a person of sound cognitive abilities. A lap sash for example is a restrain as such because the simple knot can be put to the side of a chair whereby the patient can untie it and therefore be free to stand up and walk. However its a form of cheating as pts with dementia have reduced capacity for spatial problem solving. So by "stopping" dementia pts from wandering, they somewhat manage falls risk.
Marskell, you will find that pts with aggressive behaviour in their dementia are usually given antiphyschotics which like it or not has the effect of chemically restraining a patient. This is true of those suffering from dementia with lewy bodies or even some alzheimers which have strong tendencies to be aggressive. In this case, the medical staff would be responsible for the patient. The doctor would be responsible if its a regular order but the nursing staff maybe jointly liable or responsible if its a PRN used incorrectly. Hope this information has been helpful
cheers
