1. ADVANCE DIRECTIVES

2. WHAT 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

3. FORMS 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
Primary physician must be notified that an Advance Directive has been signed

4. FORMS 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
Must be completed when individual is competent to make own health care decisions
Documented in medical record by physician & includes the names of the witnesses

5. WHAT 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

6. FORMS 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).

7. FORMS OF ADVANCE DIRECTIVES Out-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.

8. FORMS 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

9. Can 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

10. ADVANCE 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

11. ADMISSIONS 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

12. NURSING 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

13. TO ACCESS ADVANCE DIRECTIVES IN PATIENT PROFILE
Click on downward arrow to bring up Advance Directives

14. DOCUMENTING ADVANCE DIRECTIVES
Click on Pencil
Click on pencil

15. CLICK ON “Adv. Directive” (#2), drop down box to bring up types of Advance Directives

16. DOCUMENT TYPE OF ADVANCE DIRECTIVE (#2)
Click “Save” after each choice
May choose more than one

17. Check “Doc in Chart “ when copy placed in chart
ADD 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