Description of the Problem: In the past at Baycrest, consent had to be re-obtained annually and had to be in writing. As many Baycrest patients have cognitive impairments, they are incapable of providing informed consent, which is why the task is delegated to substitute decision makers.
Most substitute decision makers are not readily available on site to sign a consent form. Hence, immunization campaigns used to take months to complete, often leaving patients unprotected. Staff had to spend significant amounts of time pursuing substitute decision makers. On occasion, patients were immunized without informed consent.

Leading Practice: Infection Prevention and Control developed and implemented a process to obtain enduring consent. Signed once, it remains valid for as long as the patient is at Baycrest. A process was created for obtaining a verbal enduring consent allowing substitute decision makers to provide consent verbally over the phone. Prior to implementation, Infection Prevention and Control (IPAC) engaged the Family Advisory Council (FAC) in discussions about enduring consent. The new practice was endorsed by the FAC and at present time, new clients admitted to Baycrest receive information about enduring consent as part of their admission package

The process is as follows:
•Client/family receives and reviews a copy of consent (e.g. on admission) and discusses it with an attending physician
•If consent is provided, nurse documents it in client’s chart
•Enduring consent remains on file for all future influenza seasons

Impact-The impact of enduring consent at Baycrest since the fall of 2012 is the following:
 •The time required to attain the target rates of immunization decreased from an average of 12 weeks to 5 weeks, with >80% of all patients immunized within 3 weeks;
•Most recent (2014-15) influenza immunization rates stood at 84%, 93.5% and 91.1% for Hospital, Nursing Home and Assisted Living Facility, respectively;
•Due to mandatory structure of consent fields, 100% of patients with documented immunization have consent fields completed in the electronic health record.

Enduring consent helps avoid undue delays with immunization and facilitates timely immunization of clients early in the influenza season. For substitute decision makers, it voids the task of providing repeat consent every season and the verbal route of consenting eliminates the need for the substitute decision maker to be present on site at the time of consenting.

Disclaimer regarding Compliance with Government Acts:
Baycrest Legal Counsel deemed enduring consent to satisfy requirements of the Health Care Consent Act and Long-Term Care Home Acts (for the province of Ontario).

Contact Information:

Title: Director, Infection, Prevention and Control

Contact information: camirov@baycrest.org

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