What is Advance Care Planning It is a regulatory requirement that we inquire about the presence of an Advance Directive and offer assistance in completing one for each inpatient admission At CMC we are dedicated to providing assistance with the documentation storage retrieval and honoring of ID: 916294
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Slide1
Advance Directives
Mini Hanspal RN, BSN, CMSRN
Slide2What is Advance Care Planning
It is a regulatory requirement that we inquire about the presence of an Advance Directive and offer assistance in completing one for each inpatient admission.
At CMC, we are dedicated to providing assistance with the documentation, storage, retrieval, and honoring of patients’ advance care planning as it is essential for providing quality that reflects the goals and values of our patients.
Slide3Terminology
The most common document that can result from advance care planning is the
Advance Directive
. Every adult should have an advance directive, no matter if they are healthy or ill.
A patient with an advance directive has designated a person to be their
health care agent
.
The purpose of an
agent
is to speak in the place of the patient when the patient cannot speak them for themselves.
Slide4Terminology
If there is no advance directive naming a healthcare agent, we use California Consent law guidelines to determine the appropriate surrogate decision maker.
It is best to allow a patient to name their surrogate decision maker. If we don’t have one on record for an admission, one will be chosen for the patient, if they lose the ability to make their own decision.
Slide5Assessing for Advance Directive
Nursing does not inquire about patient preference for code status.
This discussion is outside nursing scope of practice.
The provider is responsible to address code status with the patient or their agent.
If a patient requests a code status other than “full code”, notify the provider of their request and document the discussion.
Slide6Advance Care Planning Documents
ACP wishes can be documented in different ways:
Advance Directive -
POLST
Oral Directive
Slide7Slide8Oral Directive
A patient who has decision making capacity has the right to give verbal statement about their medical care
If a patient expresses the desire to dictate an oral directive, the RN must document the request in the patient’s chart and notify the provider.
Slide9Oral Directive
If a patient wishes to give an oral directive on this admission, select this and the provider will be alerted with a banner. In some cases a call to the provider is appropriate.
Remember, the oral directive and code status discussion is the responsibility of the provider.
Slide10Advance Care Documents
Do not chart a document that you do not see.
If family agrees to bring a document, chart when you receive the document.
Slide11ACP Navigator
Slide12RN Role:
Assess for existing documents on admission
Confirm available documents
Enter the appropriate document information
Do not chart a document unless you see it.
Document agent or surrogate information.
Update ACP navigator as new information is obtained.
Slide13Questions?