The following are guidelines for the implementation of refusal of HRAC treatment or services:

1) The "Refusal of Treatment or Services" protocol is implemented when an individual's refusal meets a "standard of concern": a) refuses a treatment or service repeatedly and/or b) refuses a treatment or service that has the potential to place the individual at imminent risk to health or safety.

This Would Not Include

• A one time refusal or occasional refusal of medication.

> The occasional refusal of therapy.
> Refusal of medical procedures that do not meet recommended standards of care or prevention, i.e.
annual audiological, in which the primary care physician feels there in no adverse consequence.
> A one time refusal or occasional refusal to participate in training.

Some Examples This May Include

• Repeated refusal of a medication that has the potential for an adverse effect on the individual, i.e. seizure medication, insulin, blood pressure medication, psychotropic medication, etc.
• Ongoing refusal to follow a recommended diet which could have a serious impact, i.e. diabetic diet, individual with Prader Willi, morbid obesity.
• Refusal of medical treatment or prevention that are standard recommendations of care, i.e. dental visits, physicals including visits to the ob/gyn, mammograms, diagnostic or recommended lab work.
• Repeated refusal to participate in training.
• Refusal to follow safe sex practices.
• Refusal of C-Pap.

2) In the event an individual refusal meets the "standard of concern", this issue must be made know to the Program Coordinator, Program Nurse, and Program Director. It is the responsibility of the Program Coordinator to convene an interdisciplinary meeting that includes the individual and, if applicable, his/her family member, advocate, psychologist, physician, direct support staff, etc.

3) The "Protocol/Worksheet for Refusal of Service" and a sign in sheet of those attending the meeting is completed.

4) Depending on the outcome of the meeting, the foIlowing will occur:

1. The individual agrees with the service/ treatment, an alternate service/ treatment, or a modified service/ treatment.

1. The "Protocol Worksheet for Refusal of Treatment or Services" and the sign in sheet are placed in the individual's File.
2. The team reviews the status at the next quarterly review.
3. A completed copy is forwarded to QI.

2. The individual refuses service/treatment, but the team does not feel this places the individual and/or agency in an at-risk situation.

1. The "Protocol Worksheet for Refusal of Services" and the sign in sheet are placed in the individual's File.
2. The Program Director is informed of the outcome.
3. The team reviews the status at the next quarterly review.
4. A completed copy is forwarded to Q1.

3. The individual refuses the service/treatment and the team feels refusal places the individual and/or agency in an at-risk situation.

1. The "Protocol Worksheet for Refusal of Services" and the sign in the sheet are placed in the individual's File.
2. The Program Director and CEO are informed of the situation.
3. A copy is forwarded to Quality Improvement for review by the Human Rights Committee (HRC).
4. The individual and team representatives meet with the HRC.
5. The HRC reviews the case and makes recommendations to the individual and team.
6. In the event a decision is made to discharge the individual, the Program Director will inform the CEO.