Advance Directives are instructions created by an individual to administer withhold or withdraw lifesustaining procedures in the event of a terminal or irreversible condition These instructions explain the individuals wishes for health care in the event they become incompetent or otherwise me ID: 908277
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Slide1
ADVANCE DIRECTIVES
Slide2WHAT ARE ADVANCE DIRECTIVES
Advance Directives
are instructions created by an individual to administer, withhold, or withdraw life-sustaining procedures in the event of a terminal or irreversible condition
These instructions explain the individuals wishes for health care in the event they become incompetent or otherwise mentally/physically incapable of communication
Advance Directives only go into effect when the individual becomes a “qualified patient”. A “qualified patient” means a patient with a terminal or irreversible condition who is incompetent
or
otherwise
mentally/physically incapable of
communication
This condition is diagnosed & documented in writing in the medical record by the primary physician
Slide3FORMS OF ADVANCE DIRECTIVES
Written Directive (“Living Will”)
Written instructions explaining the individual’s wishes for health care in the event that they become incompetent or incapable of communicating their wishes
Legal document that must be completed when individual is competent to make own health care decisions
P
rimary physician must be notified that an Advance Directive has been signed
Slide4FORMS OF ADVANCE DIRECTIVES
(continued)
Non-written Directive
Issued by non-written communication in the presence of the primary physician and 2 witnesses one of which must be a qualified witness
M
ust
be completed when individual is competent to make
own
health care decisions
Documented in medical record by physician & includes the names of the witnesses
Slide5WHAT IS A QUALIFIED WITNESS
A competent adult witness who is
not
:
Family member
Person designated to be the Medical POA
Primary physician or their employees
An employee of the health care facility that is providing direct patient care, an officer, director, partner or business officer
Anyone who could claim part of individual’s estate
Slide6FORMS OF ADVANCE DIRECTIVES(continued)
Out-of-Hospital Do Not Resuscitate ( DNR) Order
Legally binding DNR order using form specified under the Health & Safety Code
Signed by individual’s primary physician
Directs health care professionals in an out-of-hospital setting not to initiate or continue life sustaining treatment
Does not include authorization to withhold medical interventions or therapies considered necessary to alleviate pain, provide water & food and other comfort care measures
Applies to following settings: nursing homes, in-patient hospice facilities, hospital outpatient or emergency departments, physician offices, private homes & transport vehicles (ambulances).
Slide7FORMS
OF ADVANCE DIRECTIVESOut-of-Hospital Do Not Resuscitate ( DNR) Order
(cont)
For inpatient
admissions,
initiating from the
ECC,
when the
patient
presented
with an
“
Out-of-Hospital
DNR
”,
the ECC physician/nurse will confirm with the patient/family and/or the duly authorized representative of the patient what code status they desire. If the patient desires any type of code status other than a full code, the ECC physician will write the appropriate admitting code status order and the nurse responsible for the care of the patient
will
place the appropriate code status identification bracelet prior to the patient leaving the ECC.
Slide8FORMS OF ADVANCE DIRECTIVES(continued)
Medical Power of Attorney (POA)
Document that delegates authority to an agent or agents to make health care decisions for the individual issuing the Medical POA document, should that individual become unable to make those decisions
Medical POA cannot make decisions for that individual until the physician has determined individual unable to make own health care decisions
POA is obligated to follow the wishes of the individual when making decisions on their behalf
Slide9Can Advanced Directives Be Revoked?
Advance Directive become invalid if the individual is determined to be pregnant.
Advance
directives can be revoked at anytime regardless of individual’s ability to make a competent
decision
The individual who signed the Advanced Directive or anyone in that person’s presence, may physically destroy the
Directive
The individual may submit a written, signed & dated document revoking the Directive
The individual may verbally communicate intent to revoke Advance Directive
Revocation does not go into effect until physician has been notified of the written or verbal revocation.
Physician must document in medical record the date, time & if oral revocation the place of notification
The word “VOID” must be written on each page of Directive in patients chart
Slide10ADVANCE DIRECTIVE
A PATIENT RIGHT & TEXAS STATE LAW
In accordance with Texas state law & federal law OBMC patients have the right to receive information concerning Advance Directives
If they have Advance Directives, they have the right to have them honored by physicians & hospital staff
The first step is to determine if the patient has Advance Directives
Slide11ADMISSIONS PROCEDURE
Admissions asks all inpatient admissions if they have Advance Directives
A copy of Advance Directives is placed in the chart by admissions, if available at that time
Patients who have an Advanced Directive but did not bring to hospital are advised to do so.
Admissions gives inpatients and observation patients a “PATIENT GUIDE” booklet which includes patient rights and information on Advance Directives.
Patient or designee initials receipt of information on admission form
Slide12NURSING UNIT PROCEDURE
Primary nurse is responsible for documenting the status of the patient’s Advance Directive when performing the Admission assessment
Advance Directives are documented under the “Patient Profile”
Click the icon
Slide13TO ACCESS ADVANCE DIRECTIVES IN PATIENT PROFILE
Click on downward arrow to bring up Advance Directives
Slide14DOCUMENTING ADVANCE DIRECTIVES
Click on pencil
Click on Pencil
Slide15CLICK ON “Adv. Directive” (#2), drop down box to bring up types of Advance Directives
Slide16DOCUMENT TYPE OF ADVANCE DIRECTIVE (#2)
May choose more than one
Click “Save” after each choice
Slide17ADD NOTES (# 3)
Check “Doc in Chart “ when copy placed in chart
Add notes to clarify, for example,” Patient declined information on Advanced Directives” or “Son, John will bring copy of Living Will this afternoon”.
It is a Patient Right to have their Advance Directive honored by their physician and hospital staff in accordance with federal & Texas law