Below is a quick summary of Managed Risk Agreements in Carewest. A short quiz is at the end. 
Carewest is committed to person-centred care that supports the individual’s desire to make informed choices to live with some risk. Living at risk means that the client, and where appropriate the client’s legal representative, understands the potential risks associated with a decision or action, and that they accept the possible negative health outcomes. 
  •  Living at risk only relates to personal risk and does not include placing others at risk, including other clients, visitors, or Carewest staff.
  • To make informed choices, clients and their legal representatives must be fully aware of potential negative health outcomes. 
  • The Client Service Manager (CSM) and the team work together with the client/legal representative to identify risk management strategies which enable the choice but reduce the risk, where possible.
  • A Managed Risk Agreement is a tool to document those discussions and strategies, and to communicate this plan as part of the Health Record.
  • Strategies outlined in the agreement must be included as part of the care plan.
Managed Risk Agreements (MRA) are required when a client with capacity or legal representative such as a guardian or agent express desire to live at risk related to a recommended care decision and after having been informed of the potential negative health outcomes of that risk.

A specific decision maker shall not enter into a MRA on behalf of a client who lacks capacity.

A Managed Risk Agreement is only finalized after the following are in place:
  1. There is a documented discussion of the potential health risks to that client.  This discussion is documented in the Total Team Record (TTR).
  2. The CSM, team, the client/legal representative, and physician agree on strategies to reduce potential risk.
  3. The CSM has signed and dated the document.
  4. The client/legal representative has signed and dated the document.
Managed Risk Agreements are intended to address living at risk only where the risk is personal and cannot be created where the risk puts others (other clients, Carewest staff, volunteers, or visitors) at risk.
Where do I find blank copies of the Managed Risk Agreement to document this process?  
  • In Careweb, under Clinical Forms
What happens to the Agreements once they are signed and dated? 
  •  The original copy should be placed in the health record and noted on the care plan.
  • The client or legal representative receives a copy.
When is the Agreement reviewed? 
  • At least annually at care conferences
  • When the client’s health status changes
  • When the client or legal representative wants to change or cancel the agreement
Who do I contact for more information?
  • Manager, Clinical Standards and Nursing Practice

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* 1. First name (as it appears on your application)

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* 2. Last Name (as it appears on your application)

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* 3. Carewest site

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* 4. Unit

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* 5. Managed Risk Agreements support the client’s right to make an informed choice to

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* 6. Where is the Managed Risk Agreement policy found?

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* 7. “Living at risk” means the client or legal representative

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* 8. Blank versions of the Managed Risk Agreement are

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* 9. A Managed Risk Agreement can be signed when

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* 10. The Managed Risk Agreement should describe

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* 11. After the Managed Risk Agreement is signed, where do copies go?

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* 12. Anyone on the care team can sign the Managed Risk Agreement on behalf of Carewest.

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* 13. Managed Risk Agreements can be signed for people who want to smoke in their room

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* 14. When is a Managed Risk Agreement reviewed?

Thank you for completing the quiz. You will be required to complete any question you skipped before submitting.

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* 15. Living at risk only relates to personal risk and does not include placing others at risk, including other clients, visitors, or Carewest staff.

Managed Risk Agreement is not the same as a waiver that removes Carewest from any legal liability.

Legal representatives must act in the best interests and safety of the individual and not place them at undue risk.

The team should involve the physician when the representative makes health care choices that put the client at risk.

A Managed Risk Agreement cannot e enacted if the client or legal representative refuses to sign the agreement.
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