> I doubt whether many patients having an MI have capacity -
> especially after
> IV opiates.
I'd disagree with you on that point. Provided the patient can understand the
nature and consequences of their treatment and weigh up the factors in their
mind, they are competent to make the decision. IV opiates do not prevent
this.
My worry and question concerns mainly time: trying to achieve a 20 minute
door to needle time (of which 5 minutes is often taken up by parking the
ambulance, offloading and moving the patient to a bed/ trolley) doesn't
leave you with a lot of time. Generally I like to take upwards of 5 minutes
to obtain written consent (explaining, leaving the patient to digest the
information, returning for further questions etc.), so hitting 20 minutes
leaves little scope for delay. Is anyone taking written consent and still
hitting their targets most of the time? How much delay if any is introduced
by taking written consent?
> We use a standardised proforma which includes incidences of
> complications
> which can be ticked as the physician explains them to the
> patient - this
> forms part of the clinical record.
I don't have such a proforma, but it sounds like a good idea and I'm always
looking out for good work to plagiarise shamelessly. To spare the work of
reinventing the wheel, could you let us know what you have on the proforma-
or have you taken it from elsewhere?
Matt Dunn
Warwick
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