Capacity and Decision-Making Tools and Strategies

November 7, 2014 | Aging Services Risk, Quality, & Safety Guidance

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​Because informed decision making is critical to safe patient and resident care, healthcare providers must be aware of the distinction between "capacity" to decide and "competency" and avoid using the terms interchangeably, said Ruth Nayko, RN, BSN, MBA, CPHQ, CPHRM, assistant vice president, risk management, Allied World, at the American Society for Healthcare Risk Management annual conference in Anaheim, California, on October 28, 2014. "Competency" is a legal decision made by a court in accordance with state law, she explained, whereas "capacity" is a physician's determination of the individual's ability to decide, based upon a clinical assessment using a capacity assessment tool. She identified 10 myths that should be dispelled about capacity. The notion that decision-making capacity is an "all or nothing" phenomenon, for example, is a myth that should be dispelled because "capacity" refers to making the decision at hand. For example, individuals may be able to consent to a simple treatment intervention while not having the capacity to make a complex medical decision, she noted.

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