Patient refuses vital signs monitoring on clozapine titration

Law and practice Other
1

Hi
One of our patients detained under section 3, keep on refusing vital signs monitoring and blood tests. He complained about body pain and feeling dizzy. One of our team members told him no leave until his physical health obs compleated. Do nurses have any legal rights to withhold leave due to his physical health condition.
Please advise as I am newly qualified and not having sound knowledge in MHA.

2

Yes.If the patient has no capacity,under MCA,to save life as you donot know the severity of the physical health problems,the team need to act/treat while he there for treatment.

1 Like
3

I’d be careful. Withholding leave sounds awfully coercive and controlling to me. Treatment for mental disorder, as defined in s145, may cover some such treatment. As does s63 but has to meet the relevant criteria.

4

I am confused, not sure how to solve this. Tried to convince patient several time but no results, he is a chain smoker and used to smoke 3 to 4 cigarettes while on S17 leave and he got plenty of leave. That’s why we tried to do it by saying “ we are worried about your physical health condition and you must cooperate with us vital signs monitoring otherwise we can’t sign you out” . But he refused it by saying he is alright and don’t care about what we says.

5

I think there are two possible ways you could formalise the ward nurses’ power to prevent the patient going on leave.

The responsible clinician could grant leave at the nurses’ discretion. Alternatively, the responsible clinician could grant leave subject to a condition that the patient has had the necessary checks within a certain period before going on leave.

Like Leena, I think that the checks would probably fall within the definition of “medical treatment for mental disorder” as a necessary component of safely prescribing clozapine. As such, they could in theory be given without the patients consent (if that were practicable and justified in all the circumstances).

Not suggesting any of this would necessarily be a good idea, though. Presumably alternatives to clozapine gave been ruled out ?

6

Thank you everyone for your support. I will request consultant to add a note on his S17 leave authorisation. Do I need to do datics/inphase for this. I updated risk assessment and updated his care plan as well. But not sure about datics