Advance Directives Policy Changes

Wednesday, June 27, 2012 at 11:42:57 AM

A recent Department of Health/CMS survey found concerns with enforcement of advance directives policies at UHS. As a result, procedures are being revised and strengthened. The summary of the policy and procedure is attached, but the following items should be stressed:
> P. 1&2 are the definitions of terms used in the policy. Personal Representative is used to cover health care proxies, surrogates, or other appropriately authorized individuals.
> All patients over 18 or emancipated minors will be offered advanced directives, except when such interaction is impossible. They will be asked if they possess Advance Directives, what type, and if they include a DNR. [See 1(i)(a)]
> If patients donít have an Advance Directive, they will be asked if they desire to establish a health care proxy or DNR order.
> Patients with appropriate capacity have sole authority to make their own DNR decisions. No DNR Order will be issued, suspended, or canceled against a capacitated patientís wishes. If capacity patients become incapacitated, their Personal Representative may make the decisions, as long as they donít contradict what the patients documented when competent.
> The Attending Physician must co-sign all verbal or telephone DNR Orders, and all of those entered by residents or Advanced Practice Professionals within 24 hours. If this doesnít occur, there may be one final telephoned 24 hour renewal, and then the Medical Staff ďChain of CommandĒ will be initiated.
> A DNR Order shall remain in effect during a surgery/procedure unless PRIOR to a surgery/procedure, the patientís Proceduralist discusses suspension with the patient/Personal Representative and documents it on the procedural consent form. Such suspension will cease when the patient is discharged from the procedural area or upon the Proceduralist determining the Surgery/Procedure completed.
> DNR orders will no longer require review every seven (7) days.

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