P was deemed to have capacity to make an informed choice on his medication and he consented to the patches. His carers were instructed on the use of the new medication and administering techniques and he was referred for follow up at the dementia clinic. He made good progress on the patches which were well tolerated with no further deterioration in cognitive skills. It was considered clinically http://www.selleckchem.com/products/Perifosine.html appropriate Inhibitors,research,lifescience,medical to continue on the patches. Reflective notes to consider Suitability of patch over oral preparation. Patient preference. Analysis of nature and reliability of carer support. Analysis of

any ongoing or planned changes to social factors, for example, will P be moving to a residential/nursing home? Risk assessment around medication administration and storage. Reviewing capacity to consent, any advance directives and future choices of medication. Review of improvement on cognition, daily living and patient experience. Specialist follow up at dementia clinic. Case vignette 2 J is a 50-year-old woman with moderate learning disability Inhibitors,research,lifescience,medical (LD) and autism. She lives in a residential care setting. Following investigation for postmenopausal bleeding, J was recommended for hormone replacement therapy (HRT) and was prescribed HRT patches. After a period of initial adherence on the patch,

J started refusing to wear them as prescribed by the physician. It was reported later Inhibitors,research,lifescience,medical on that some of the carers at the residential home were seen to be forcing J to wear the patches .The manager

of the residential home is now seeking advice management on issues around Inhibitors,research,lifescience,medical the patient’s capacity to refuse HRT patches. Reflective notes to consider Face-to-face interview and collect factual details from all parties involved, preferably using a multiprofessional team. Individuals with social and communication disorder such as autism may require specialist analysis and input from a speech and language therapist or an occupational therapist Inhibitors,research,lifescience,medical to identify communication difficulties and sensory problems such as tactile hypersensitivity. Using visual cues such as pictures or picture exchange communication systems may facilitate J’s understanding of Cilengitide the need for a particular medication. Medical basis of prescribing patch, what are the alternatives? Consider patient choice. Capacity to consent is context and issue specific. Make reasonable adjustments and appropriate measure to improve capacity, for example, providing accessible information, treatment of underlying physical or mental illness, if any. If J is deemed to have no capacity to consent to treatment, initiate a best interest meeting and consider involvement from independent mental capacity advocates. Involving specialist mental health services or family physicians can help facilitate complex decisions. If in doubt, seek advice on click this procedure for safe guarding vulnerable adults procedure.