ADVANCED DIRECTIVES

ADVANCED DIRECTIVES

ORIENTATION TO ADVANCE DIRECTIVES

TRAINING TOPIC: Advance Directives

PURPOSE:To educate the new home health employee in the client’s/patient’s right to make Advance Directives.

OBJECTIVES:The employee will have express knowledge of Advance Directives, understand how to honor a client’s/patient’s Advance Directive and be able to recognize an Out of Hospital Do Not Resuscitate Order.

Upon admission to home health care, each individual is provided with written information regarding his/her right to make decisions about medical care, and to accept or refuse medical or surgical treatment. This may include verification of decisions made in a Living Will or Directive to Physician or in a Medical Power of Attorney. It may also include determinations needed to implement specified treatment when terminal illness or client/patient incompetence is a factor. Clients/Patients and families are encouraged to discuss the issue with their physician and/or attorney. Any interaction and coordination of services is to be documented in the clinical record. All patients will be treated with acceptable professional standards of care without discrimination, and the presence or absence of an Advance Directive will not affect the quality of care provided by the Agency.

DIRECTIVE TO PHYSICIAN

1. Sets out the desires of a person ahead of time

2. Directs the physician to withhold or withdraw Life-sustaining procedures when the patient becomes “qualified”

3. Qualified patient means a patient with a terminal condition that has been diagnosed and certified in writing by the attending physician and one other physician who has examined the patient

4. Terminal condition means an incurable or irreversible condition which would produce death without the application of life-sustaining procedures, or only postpone the moment of death with the application of life-sustaining procedures.

MEDICAL POWER OF ATTORNEY (MPOA)

1. Allows the person to appoint someone to make health care decisions for him/her if he/she is no longer able to make decisions for himself/herself

2. Does not include the requirement that the patient be terminally ill

3. The MPOA becomes effective only when the patient is incapacitated

4. The patient should pick a strong patient advocate who will not be intimidated by physicians or other family members

5. In the absence of MPOS, the laws turns decision making authority over to the relatives in the following order of priority (a court appointed legal guardian may take the place of a relative), but a court may decide that the decision maker is not acting in the patient’s best interest

a. Spouse of patient

b. Adult of the patient who has the consent of the other adult children to act as the decision maker

c. A majority of the patient’s available adult children

d. The patient’s parents

e. The person clearly identified to act for the patient by the patient before the patient became incapacitated

OUT OF HOSPITAL DO NOT RESUSCITATE (OOHDNR)

1. Allows the patient to refuse life-sustaining treatments in any setting outside of a hospital

2. Protects EMS personnel from liability

3. Must use the State approved form

4. Does not require a terminal condition, except for minors

5. Requires the signature of the patient or proper person acting on behalf of the patient, two witnesses and one physician

6. Patients who want a DNR are not required to use the state form, however EMS personnel may not honor any form but the state form

7. If the patient was a DNR in the hospital, you must obtain an OOHDNR for home care.

DEATH AND DYING/DETERMINATION & PRONOUNCEMENT OF DEATH

All clinical personnel should receive information regarding death and dying to optimize patient dignity and comfort, and facilitate coping mechanisms demonstrated by patient and family. A RN may pronounce a patient dead and complete the “Determination and Pronouncement of Death by a Registered Nurse” form according to State law and agency policy. There also must be in place an appropriate DNR order. This includes the “Physician’s Agreement for Pronouncement of Death by a Registered Nurse.” All patient care team members must be informed of each patient’s choice regarding Advance Directives.

POINTS TO REMEMBER ABOUT ADVANCE DIRECTIVES

1. The patient is legally entitled to make informed decisions about accepting or refusing medical care.

2. Health care providers are required to educate patients and the public about Advance Directives.

3. The making of an Advance Directive is not a requirement for the admission to health care services.

4. The contents of an Advance Directive should be communicated to all health care providers.

5. Advance directives can be revoked or changed at any time.

6. Attorneys are not required to prepare a directive, but each directive must be legally executed.

7. Directives must be executed by competent adults.

8. Directives can be written and oral.

9. Directives must be witnessed by two witnesses who affirm that the patient states in their presence that the patient was aware of the nature of the directive and that the patient signed it voluntarily and free from duress, and at least one of the witnesses must meet the following requirements:

a. Cannot be the person designated as agent

b. Cannot be a health or residential care provider or an employee of the patient’s health or residential care provider

c. Cannot be related to the patient by blood or marriage

d. Cannot be lawful heirs or beneficiaries named in the patient’s will or a deed

e. Cannot be a creditor or person who have a claim against the patient’s estate cannot be a patient in the health care facility in which the declarant is a patien

ADVANCE DIRECTIVES TEST

T F 1. It is patient’s right to receive information regarding advance directives.

T F 2. A living will is the same as a Do Not Resuscitate order.

T F 3. Patients should be instructed to have copies of all advance directives available to all healthcare workers.

T F 4. Only a physician can pronounce death in the home care setting.

T F 5. A patient Must contact an attorney to complete any advance directive.

T F 6. A Medical Power of Attorney is the same thing as a Durable Power of Attorney.

T F 7. If the patient was a DNR in the hospital, you can use that order in home care.

T F 8. There are three types of advance directives and a patient might have all three.

T F 9. All clinical staff must be made aware of the patient’s advance directives.

T F 10. A patient must have some sort of advance directive before being admitted to home care.











ADVANCE DIRECTIVES TEST ANSWER KEY

T 1. It is patient’s right to receive information regarding advance directives.

F 2. A living will is the same as a Do Not Resuscitate order.

T 3. Patients should be instructed to have copies of all advance directives available to all healthcare workers.

F 4. Only a physician can pronounce death in the home care setting.

F 5. A patient Must contact an attorney to complete any advance directive.

F 6. A Medical Power of Attorney is the same thing as a Durable Power of Attorney.

F 7. If the patient was a DNR in the hospital, you can use that order in home care.

T 8. There are three types of advance directives and a patient might have all three.

T 9. All clinical staff must be made aware of the patient’s advance directives.

F 10. A patient must have some sort of advance directive before being admitted to home care.