How do I document patient giving consent for taking medications in ICANotes?

How do I document patient giving consent for taking medications in ICANotes?

How do I document patient giving consent for taking medications in ICANotes?

Please take the following steps to document medication consent within the ICANotes standard medication list.

 

In order to mark consent for medication within the ICANotes medication list, we begin within a  Progress Note.

 

From there, we would select  at the top of the tabs.

 

From PN, part 2, we select  to view our medications list.

 

This allows you to enter the medication, route, timing -- and at the end of the row, you will see 'Consent'.

 

 

 

Clicking on the Consent box will bring up a Consent pop-out screen --

 

  

 

Select the Consent Given By drop-down and choose the person providing consent for the medication; once you've done so, click the  button. Alternatively, if you need to back out of this screen, you may also click  

 

If patient/parent gives consent for the ordered medication to be taken, the medication will now appear with a green checkbox on the screen, like so:

 

This also means that it will push into the MAR, Chart Face Medication List, and the Medication Log.

 

When viewing the MAR, the clinician will see a green checkbox indicating that permission to receive this medication has been received.

 

 

 

To document a denial of consent from the patient, you would enter your medication, click on the Consent box and mark it as Does Not Consent, like so:

 

 

 

However, the Zyprexa will not push into the MAR, Chart Face or Med Log when this note is compiled, and a comment must be added to explain the denial, otherwise you will receive an error when clicking Done.

 

To get a better idea of how this works in real-time, please check out the following video!