How these processes are carried out in an

PATIENT AND FAMILY RIGHTS

BAYRO, ARIANE MARIE B I S M O N T E , PA T R I C I A A U D R E Y

organization depends on its countrys laws and regulations and any or international on conventions, treaties, agreements

human rights endorsed by its country. These processes are related health to care how in an an

OVERVIEW
Each patient is unique, with his or her own needs, strengths, values, and beliefs. Health care organizations work to establish trust and open communication with patients and to understand and protect each patients cultural, psychosocial, and spiritual values. Patient care outcomes are improved when patients and, as appropriate, their families or those who make decisions on their behalf are involved in care decisions and processes in a way that matches cultural expectations. To promote patient rights in a health care organization, one starts by defining those rights, then educating patients and staff about those rights. Patients are informed of their rights and how to act on them. Staff are taught to understand and to respect patients beliefs and values and to provide considerate and respectful care that protects patients dignity.

organization

provides

equitable manner, given the structure of the health care delivery system and the health care financing mechanisms of the country.

STANDARDS PFR.1 The organization is responsible for

providing processes that support patients and families rights during care.
The organizations to leaders and work advance

collaboratively

protect

patient and family rights. The leaders understand patient and family rights as identified in laws and regulations and in relation to the community served. The organization respects the right of patients, and in some circumstances the right of the patients family, to have the prerogative to determine what information regarding their care would be provided to family or others, and under what circumstances. Staff members are knowledgeable about the policies and procedures related to patient rights and can explain their responsibilities in protecting patient rights. Policies and procedures guide and support patient and family rights in the organization.

PROCESSES
1. Identifying, protecting, and promoting patient rights 2. Informing patients of their rights 3. Including the in patients family, about when the appropriate, patients care 4. Obtaining informed consent 5. Educating staff about patient rights decisions

PFR.1.1 Care is considerate and respectful of

the patients personal values and beliefs.
There is a process to identify and respect patient values and beliefs, and when applicable, those of the patients family. Staff use the process and provide care that is respectful of the patients values and beliefs.

The organization has a process to protect patients from assault. Infants, children, the elderly, and others less able or unable to protect themselves are addressed in the process.

Individuals investigated.

without

identification

are

Remote or isolated areas of the facility are monitored.

PFR.1.1.1 The organization has a process to respond to patient and family requests for pastoral services or similar requests related to the patients spiritual and religious beliefs.
The organization has a process designed to respond to routine as well as complex requests related to religious or spiritual support. The organization responds to requests for religious or spiritual support.

PFR.1.5 Children, disabled individuals, the

elderly, and other populations at risk receive appropriate protection.
The organization identifies its vulnerable patient groups. Children, disabled individuals, the elderly, and others identified by the organization are protected. Staff members understand their responsibilities in the protection processes.

PFR.1.2 Care is respectful of the patients

need for privacy.
Staff members and identify needs for patient privacy

PFR.1.6 Patient information is confidential.

Patients are informed about how their information will be kept confidential and about laws and regulations that require the release of and/or require confidentiality of patient information. Patients are requested to grant permission for the release of information not covered by law and regulation. The organization respects patient health information as confidential.

expectations

during care and treatment. A patients expressed need for privacy is respected for all examinations, and transport. clinical interviews, procedures/treatments,

PFR.1.3 The organization takes measures to

protect patients possessions from theft or loss.
The organization has determined its level of responsibility for patients possessions. Patients receive information about the organizations responsibility for protecting personal belongings. Patients possessions are safeguarded when the organization assumes responsibility or when the patient is unable to assume responsibility.

PFR.2 The organization supports patients

and families rights to participate in the care process.
Policies and procedures are developed to support and promote patient and family participation in care processes. Developing policies and procedures is a collaborative effort and includes management and clinical staff. Staff members are trained on the policies and procedures and their role in supporting

PFR.1.4 Patients are protected from physical

assault.

patient and family participation in care processes.

available alternatives.

care

and

treatment

PFR.2.1 The organization informs patients and

families, in a method and language they can understand, about the process of how they will be told of medical conditions and any confirmed diagnosis, how they will be told of planned care and treatment, and how they can participate in care decisions, to the extent they wish to participate.
Patients and families understand: o how and when they will be told of medical confirmed appropriate o o how and when they will be told of planned care and treatment(s) when consent will be requested and the process used to give consent, and o their right to participate in care decisions to the extent they wish. conditions diagnosis and any when

PFR.2.3 The organization respects patient

wishes and preferences to withhold resuscitative services and to forgo or to withdraw life-sustaining treatments.
The organization has identified its position on withholding resuscitative services and forgoing or withdrawing life-sustaining treatments. The organizations position conforms to its communitys religious and cultural norms and any legal or regulatory requirements. Policies and procedures are implemented to guide the process for patients to make their decisions known to the organization and for modifying decisions during the course of care The and to guide and a the organizations were and response to patient decisions. policies procedures collaborative decisions guides developed through

inclusive process. Documentation The about follows health organization policy. organization professionals on the ethical and legal issues in carrying out such patient wishes.

PFR.2.1.1 The

organization informs

patients and families about how they will be told about the outcomes of care and treatment, including unanticipated outcomes, and who will tell them.
Patients and families understand how they will be told and who will tell them of the outcomes of care and treatment and of any unanticipated treatment. outcomes of care and

PFR.2.4

The

organization

supports

the

patients right to appropriate assessment and management of pain.

The organization respects and supports the patients right to appropriate assessment and management of pain. The organizations staff understand the personal, cultural, and societal influences on the patients right to report pain, and accurately assess and manage pain.

PFR.2.2 The organization informs patients and

families about their rights and responsibilities related to refusing or discontinuing treatment.
The o o o organization informs patients and

families about: their rights to refuse or discontinue treatment the consequences of their decisions their responsibilities related to such decisions, and

PFR.2.5
patients

The

organization to

supports

the and

right

respectful

compassionate care at the end of life.

The organization recognizes that dying patients have unique needs.

The organizations staff respects the right of dying patients to have those unique needs addressed in the care process.

and carried out by trained staff in a language the patient can understand.
The organization has a clearly defined informed consent process described in policies and procedures. Designated staff are trained to implement the policies and procedures. Patients give informed consent consistent with the policies and procedures.

PFR.3 The organization informs patients and

families about its process to receive and to act on complaints, conflicts, and differences of opinion about patient care and the patients right to participate in these processes.
Patients are aware of their right to voice a complaint and the process to do so. Complaints are reviewed according to the organizations mechanism. Dilemmas that arise during the care process are reviewed according to the organizations mechanism. Policies and procedures identify participants in the process and how the patient and family participate.

PFR.6.1 Patients and families receive adequate

information about the illness, proposed treatment(s), and health care practitioners so that they can make care decisions.
Patients are informed: o o of their condition about the proposed procedures and treatment(s) and who is authorized to o perform the procedure benefits the or and treatment about potential to drawbacks proposed

PFR.4 Staff members are educated about their

roles in identifying patients values and beliefs and protecting patients rights.
Staff members understand their role in: o identifying patient and family values and beliefs and how such values and beliefs can be respected in the care process o protecting patient and family rights. o o

treatment(s) and possible problems related to recovery about possible alternatives to the proposed treatment(s) and possible results of nontreatment about the likelihood of successful treatment(s). Patients know the identity of the physician or other practitioner responsible for their care.

PFR.5 All patients are informed about their

rights and responsibilities in a manner and language they can understand.
Each patient receives information about his or her rights in writing. The organization has a process to inform patients of their is rights not when written or communication appropriate. effective

PFR.6.2

The

organization

establishes

process, within the context of existing law and culture, for when others can grant consent.
The organization has a process for when others can grant informed consent. The process respects law, culture, and custom. Individuals, other than the patient, granting consent are noted in the patients record

INFORMED CONSENT PFR.6 Patient informed consent is obtained

through a process defined by the organization

PFR.6.3 General consent for treatment, if

obtained when a patient is admitted as an inpatient or is registered for the first time as an outpatient, is clear in its scope and limits.
Patients and families are informed as to the scope of a general consent, when used by the organization. The organization has defined how a general consent, when used, is documented in the patients record.

RESEARCH PFR.7 The organization informs patients and

families about how to gain access to clinical research, clinical investigation, or clinical trials involving human subjects.
Appropriate patients and families are

identified and informed about how to gain access to those research, investigations, or clinical trials relevant to their treatment needs. Patients asked to participate are informed about: o o o expected benefits potential discomforts and risks alternatives that might also help them o the procedures that must be followed. Patients are assured that their refusal to participate or withdraw from participation will not compromise their access to the organizations services. Policies and procedures guide the information and decision process.

PFR.6.4 Informed consent is obtained before

surgery, anesthesia, use of blood and blood products, and other high-risk treatments and procedures.
Consent is obtained before: o o o o surgical or invasive procedures anesthesia (including moderate and deep sedation) the other use of blood and blood and products, and high-risk procedures treatments. The identity of the individual providing the information to the patient and family is noted in the patients record. Consent is documented in the patients record by signature or record of verbal consent.

PFR.7.1 The organization informs patients and

families about how patients who choose to participate in clinical research, investigation, or clinical trials are protected.
Patients and families are informed about the organizations process for: o o reviewing research protocol weighing the benefits and risks to the subjects obtaining consent withdrawing from participation.

PFR.6.4.1 The organization lists those categories or types of treatments and procedures that require specific informed consent.
The organization has listed those

o o

procedures and treatments that require separate consent. The list is developed collaboratively by those physicians and others who provide the treatments and perform the procedures.

PFR.8 Informed consent is obtained before a

patient participates in clinical research, clinical investigation, and clinical trials.
Informed consent is obtained when a

patient decides to participate in clinical research, investigations, or clinical trials.

Consent decisions are documented, dated, and based on the information identified in PFR.6.4.

related

to

organ

donation

and

the

availability of transplants. The organization cooperates with relevant organizations community to and agencies and in the respect implement

The identity of the individual(s) providing the information and obtaining the consent is noted in the patients record.

choices to donate.

Consent is documented in the patients record by signature or record of verbal consent.

Reference:
INTERNATIONAL

JOINT

COMMISSION ACCREDITATION

PFR.9 The organization has a committee or

another way to oversee all research in the organization involving human subjects.
The organization has a committee or other mechanism to oversee all research within the organization. The organization develops a clear statement of purpose for the oversight activities. Oversight activities include: o o o a review process a process to weigh relative risks and benefits to subjects processes to provide confidentiality and security of research information.

STANDARDS FOR HOSPITALS, 4TH EDITION

ORGAN DONATION PFR.10 The organization informs patients

and families about how to choose to donate organs and other tissues.
The organization supports patient and

family choices to donate organs and other tissues The organization provides information to support the choice.

PFR.11 The organization provides oversight

of the harvesting and transplantation of organs and tissues.
Policies and procedures guide the

procurement and donation process, and the transplantation process. Staff are trained in the policies and procedures, and in the issues and concerns