Posted: June 1st, 2023

Topic: Dementia Patient Sexual rights_Policy and procedure manual

Topic: Dementia Patient Sexual rights_Policy and procedure manual
Paper details:

Strictly according to the example provided as a layout for writing. Prepare Clinical Policy Manual for LTC (Long Term Care Facility ) for corporate-wide implementation that addresses situations such as given in case scenario. Include guidelines for facility staff and recommendations for communicating with family members in the procedure manual.

I made my summary for your better understanding: You must observe and consider and generate recommendations as a response to the case provided scenario. It must be a policy which considers cases from the Patient Rights position. The LTC resident has the rights. More precisely the dementia resident has their own ETHICAL RIGHTS for SEXUAL ACTIVITY, PROTECTION, AND DETERMINATION OF CHelp write my thesis – APACITY.

For example:

In matters of sexual behavior by LTC residents with dementia, three fundamental rights are in focus. First, in America, all persons who have reached the age of consent (varying by state from 16-18 years) have the right to consensual sexual activity, and are presumed to have the capacity to consent, absent evidence to the contrary.

Second, all persons have the right to not have consented-to sexual aggression directed at them. LTC facilities have been found liable as third parties in cases involving RRSA leading to abuse, and are expected to take steps to mitigate the risk of unwanted RRSA that may lead to abuse.29

Third, the right to an authentic process by which LTC professionals evaluate capacity for consent by individuals with dementia in LTC engaging in sexual activity.

It must be a guidance for all parties who are involved – LTC Nursing, LTC Administration and Resident Families members in order to stay on the same page.

I would suggest to you considered my reference below, also you must have your own credible sources:

https://paltc.org/amda-white-papers-and-resolution-position-statements/capacity-sexual-consent-dementia-long-term-care

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Clinical Policy Manual
SCOPE:
AHC entities

PURPOSE:
To identify guidelines for personnel administering contrast media or radiopharmaceuticals to ensure these agents are used appropriately and properly so that imaging studies are optimized and risk to the patient is minimized.

DEFINITION:
Injected iodinated contrast media – Omnipaque (Iohexol) , Visipaque (Iodixanol) , Cysto
Conray (Iothalamate)
Injected gadolinium-based contrast agents – (GBCAs) Gadovist (gadobutrol)
Oral contrast media- Barium Sulfate Suspension, Entero-Vu, Volumen, Omnipaque
eGFR – estimate of Glomerular Filtration Rate
CVIR – Cardiac Vascular Interventional Radiology
Radiopharmaceuticals – radioactive drugs used for diagnostic or therapeutic purposes
EMR – electronic medical record

POLICY:
Procedures Requiring Injected Contrast Media or Radiopharmaceuticals
The departments of Emergency Medicine, Pharmacy, Nursing and Radiology at AHC entities have jointly developed guidelines regarding the use of contrast media and radiopharmaceuticals for radiological studies performed on patients.

Persons Certified to Administer Contrast Media or Radiopharmaceuticals
• All oral and injectable diagnostic contrast agents will be administered by qualified personnel under the supervision of the radiologist or a licensed independent practitioner. A pharmacist is not required to review the contrast or radiopharmaceutical order when used by radiology or as part of an imaging study under an approved exam protocol. The radiologist or his designee licensed independent practitioner is available for timely intervention in the event of a patient emergency.

• All persons who administer contrast media or radiopharmaceuticals must be certified in cardiopulmonary resuscitation (CPR). Qualified individuals to administer contrast media include radiologists or other physicians and, licensed, registered Radiologic Technologists and Nurses. Qualified individuals to administer radiopharmaceuticals are authorized based on the licensed, registered Nuclear Medicine Technologists scope of practice.

Contrast Media Orders (Injected and Oral)
All contrast media is considered a medication and are kept in secure areas in the Radiology
department. Contrast media administration is documented in the medical record.

Radiopharmaceuticals Orders
All radiopharmaceuticals are considered medications and will be dispensed in unit dose by the approved radiopharmacy vendor. Records are maintained within the Nuclear Medicine Department for the receipt and disposition of radiopharmaceuticals. Radiopharmaceuticals will be stored securely and will be administered by Nuclear Medicine Technologists under the supervision of a physician who is an authorized user.

Guidelines:
Administration of Injected Contrast Media in the Radiology Department
• Ensure proper identification of the patient by using two patient identifiers.
• Before administering contrast media, ensure that a radiologist, ED physician, Hospitalist or LIP (Limited Independent Practitioner) is available to respond in the event of an emergency. After 10:00 PM to 8:AM the ED physician will respond to any emergent needs upon notification by the technologist.
• A Rapid Response or Code Blue will be utilized in the event of an adverse reaction.
• The Consent for Operative, Other Invasive & Non-Invasive Procedures form is necessary for invasive procedures (i.e. lumbar puncture, hysterosalpingograms).
• An Intravenous Administration of Contrast Material Information Sheet and Acknowledgement of Risk form must be signed by adult patients prior to any examination where contrast media will be injected (i.e. COMPUTED TOMOGRAPHY (CT), IVP).
• The above forms must be signed by the parent or legal guardian of minor children and patients unable to give consent on their own prior to any examination where contrast media will be injected.
• A Diagnostic Contrast Materials Patient Questionnaire will be completed by the technologist.
• Obtain a history from the patient and medical record.
• Determine allergies and document in EMR
• Confirm pertinent indications for the exam.
• Question patient for previous injections and/or reactions to contrast media.
• Document present medications, medical history, and lab data. All Outpatients will be instructed by Centralized Scheduling to bring a list of current medications with them on the day of their exam.
• Document type and amount of contrast to be used including Lot #. In EMR

Guidelines for Injected Iodinated Contrast Media
• Any patient 60 years or older who needs IV contrast will require BUN and CREATININE blood work within 30 days prior to the test being performed.
• Any patient of any age who needs IV contrast will require BUN and CREATININE blood work within 30 days prior to the test being performed if any of the following risk factors are present:
o Renal Disease
• Dialysis
• Kidney transplant
• Single kidney
• Renal cancer
• Renal surgery
o History of hypertension requiring medical therapy
o History of diabetes mellitus
o Metformin or metformin-containing drug combinations
• Per protocol, the radiologist, according to the exam being performed, the patient’s eGFR and creatinine will determine the type and amount of contrast, and if needed rate of injection.
• eGFR equal to or greater than 30 may be performed without approval of radiologist
• If an IV infiltration or mild to moderate contrast reaction occurs, appropriate patient follow-up will occur within 2 business day by a staff member to ensure patient safety and good outcome. The patient will receive Instructions for IV Contrast Infiltrations or allergic reaction instructions.

Risk Factors for Injected Iodinated Contrast Media
• History of severe previous adverse reaction to contrast media.
• Certain reactions do not preclude the exam being performed. The ordering physician may prescribe that the patient be pre-medicated and continue with exam.
• Elevated BUN and creatinine resulting in an eGFR below 30 will typically not receive iv contrast.
• Asthma.
• Congestive heart failure.
• Diabetic patient with known renal disease.

Guidelines for Administration of Oral Contrast Media in the Radiology Department
• Oral contrast for COMPUTED TOMOGRAPHY (CT) Scan procedures are given per CT protocol.
• Oral contrast for MAGNETIC RESONANCE IMAGING (MRI) procedures are given per MRI protocol.
• Oral contrast for FLUOROSCOPY procedures are given per DIAGNOSTIC protocol under the direct supervision of the Radiologist.

Guidelines for Administration of Oral Contrast Media for INPATIENTS by Nursing
The pharmacy will place oral contrast (Omnipaqe 240, iohexol) in the Pyxis on all nursing units
except NICU.
For inpatient documentation of the Oral Contrast in the patient’s medical record:
• The physicians order for oral contrast will be entered into the EMR (electronic medical record) as no cosign per protocol.
• The CT technologist will call the floor to alert the RN that an order has been placed for oral contrast.
• The nurse will retrieve the oral Contrast with attached instructions for dilution from Pyxis.
• The oral contrast can then be given to the patient by the RN (following the dilution instructions).
• The RN should call the CT staff upon patient completing oral contrast.
• CT staff will arrange for transportation to bring patient to CT 1-2 hours after ingestion of oral contrast.

Injections through Existing IV’s
• IV products labeled as power injector compatible CAN be used for high-pressure injections:
o IV catheters at 22g and above.
o Documented power ports accessed with a power Huber needle devise
o Power PICC lines.
• Ensure injection rate and PSI (pounds per square inch) are within guidelines of product being used.
• IV infusions should not be put on hold for a period longer than needed to inject contrast media.

Guidelines for Administration of Radiopharmaceuticals
• Radiopharmaceuticals are supplied in unit doses.
• The physicians order for a Nuclear Medicine exam will be entered into the EMR (electronic medical record) as no cosign per protocol.
• The unit dose will be prepared per protocol for administration to the prescribed patient.
• Before administering a radioactive pharmaceutical for diagnostic purposes, staff verify that the dose to be administered is within 20% of the prescribed dose, or, if the dose is prescribed as a range, staff verify that the dose to be administered is within the prescribed range.
• Ensure proper identification of the patient by using two patient identifiers.
• A written directive as well as a Consent for Therapy form is necessary for administration of therapeutic radiopharmaceuticals.
• Administration is documented in the medical record.

Resuscitative Equipment Readily Available
• The contrast reaction box will be available in the imaging exam room where a patient receives an intravenous contrast media injection.
• Oxygen set-up and ready.
• Suction set-up and ready.
• Code cart.

REFERENCES:
American College of Radiology (ACR). (2017). Manual on Contrast Media (Version 10.1). Reston, VA: Cohen, James H. Ellis, MD, FACR, Chair, et al.
http://www.acr.org/Quality-Safety/Resources/Contrast-Manual
Maryland Board of Physicians (MBP). (2016). Laws and Regulations. Radiographers-Statute (§14-5B-01, Etc.). Scope of Practice-General (10.32.10.07). Baltimore, MD: Elder, Paul T., M.D., et al.
http://www.dsd.state.md.us/comar/comarhtml/10/10.32.10.07.htm
Maryland Board of Physicians (MBP). (2016). Laws and Regulations. Nuclear Medicine Technologists-Statute (§14-5B-01, Etc.). Scope of Practice-Nuclear Medicine Technology (10.32.10.10). Baltimore, MD: Elder, Paul T., M.D., et al. http://www.dsd.state.md.us/comar/comarhtml/10/10.32.10.10.htm
TJC MM.03.01.01, MM.05.01,01, MM.05.01.07, and MM.06.01.01
FDA Safety Drug Safety Communications – Regulations.gov. Yale University Citizen Petition. http://www.regulations.gov/#!documentDetail;D=FDA-2013-P-0298-0002. Published April 3, 2013. Accessed March 30, 2016. A copy of the response is available at www.regulations.gov under Docket No. FDA-2013-P-0298.

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Case scenario:
After seven years of being cared for at home for progressive Alzheimer’s disease
operated by your organization, Mrs. Dowd has been admitted to a LTC home, also part of
your corporate portfolio. Upon visiting his wife one day, Mr. Dowd finds her walking
hand-in-hand with a male resident. Staff report Mrs. Dowd has been observed following
this male resident into his room, which is immediately next to hers. Mr. Dowd becomes
angry and states, “Look, it is your job to protect my wife. Get that man out of here right
now. I don’t want her involved with any other man. That’s why I admitted her here.”
What are some of the ethical issues in this case? What do you recommend? Is Mrs. Dowd
able to understand and appreciate her actions with the male resident? Does the staff have
an obligation to intervene to protect Mrs. Dowd? Or at the request of Mr. Dowd? If Mrs.
Dowd was capable (competent), would the responsibility of the LTC home staff remain
the same?
Consider the experience of retired US Supreme Court Justice Sandra Day O’Connor,
described at https://www.telegraph.co.uk/news/uknews/1576716/Judge-lost-husband-toAlzheimers-and-love.html. Does this change your mind?

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