1. Kathy Sample BS, LSW Grace Healthcare Pat Bader FNP-BC ANP Primary Care Specialists

2. With Whom? Spouse Spouse Children Children Siblings Siblings Friend Friend Partner Partner Niece/ Nephew/ Aunt Uncle/Cousin Niece/ Nephew/ Aunt Uncle/Cousin Guardian Guardian Appointed HCA Appointed HCA

3. When? On admission to hospital? On admission to hospital? On admission to the Nursing Home? On admission to the Nursing Home? In the Assisted Living Community? In the Assisted Living Community? In the Office? In the Office? At Home? At Home? When there is a change in condition? When there is a change in condition?

4. By Whom? Physician? Physician? Nurse Practitioner? Nurse Practitioner? Social Worker? Social Worker? Case Manager? Case Manager? Admission Director in Nursing Home? Admission Director in Nursing Home? Administrator in Assisted Living? Administrator in Assisted Living? Chaplain? Chaplain? Hospice? Hospice?

5. Scripting General Recommendations Acknowledge importance of the decisions Acknowledge importance of the decisions Discuss issues with the chosen surrogate or loved one Discuss issues with the chosen surrogate or loved one Avoid communicating personal values and preferences Avoid communicating personal values and preferences First: Explore the understanding First: Explore the understanding Then: Provide the information Then: Provide the information

6. Scripting CPR/ no CPR We need to discuss whether or not you would want attempts to re-start your heart or breathing if your heart or breathing suddenly stopped We need to discuss whether or not you would want attempts to re-start your heart or breathing if your heart or breathing suddenly stopped What is your understanding of CPR? What is your understanding of CPR? Do you fears or concerns about making this decision? Do you fears or concerns about making this decision?

7. Scripting Medical Interventions You have chosen (CPR or no CPR)….. You have chosen (CPR or no CPR)….. There are 3 categories of choices to discuss: There are 3 categories of choices to discuss: Comfort Care includes measures to control symptoms you may experience Comfort Care includes measures to control symptoms you may experience Limited Interventions include IV medications, no breathing machine or intubation but usually means going to the hospital Limited Interventions include IV medications, no breathing machine or intubation but usually means going to the hospital Full Treatment requires going to the hospital and involves ICU, intubation and a respirator to help breathing Full Treatment requires going to the hospital and involves ICU, intubation and a respirator to help breathing

8. Scripting Antibiotics What do you understand about antibiotic usage? What do you understand about antibiotic usage? Antibiotics may be used for a new condition Antibiotics may be used for a new condition Antibiotics may be given by mouth or in a shot or IV Antibiotics may be given by mouth or in a shot or IV

9. Scripting Medically Administered Fluids & Nutrition What is your understanding of medically administered nutrition and hydration? What is your understanding of medically administered nutrition and hydration? Oral foods and fluids are offered if medically feasible Oral foods and fluids are offered if medically feasible Would a feeding tube be acceptable? Would a feeding tube be acceptable? Would IV fluids be acceptable? Would IV fluids be acceptable? Do you have fears or concerns about making this decision? Do you have fears or concerns about making this decision?

10. Information Transition POST should follow the patient from one point of care to another POST should follow the patient from one point of care to another Corporate regulations for POST forms should be in line with the intent of the form Corporate regulations for POST forms should be in line with the intent of the form Education is critical to appropriate use of the POST Education is critical to appropriate use of the POST POST status needs to be part of the report from one facility to another POST status needs to be part of the report from one facility to another DNR does not mean Do Not Treat DNR does not mean Do Not Treat

11. References/ Resources WEBSITES WEBSITES Center to Advance Palliative Care www.capc.org Center to Advance Palliative Care www.capc.orgwww.capc.org End of Life Physician Education Research Project www.eperc.mcw.edu End of Life Physician Education Research Project www.eperc.mcw.eduwww.eperc.mcw.edu Growth House www.growthhouse.org Growth House www.growthhouse.orgwww.growthhouse.org MOLST resources www.compassionandsupport.org MOLST resources www.compassionandsupport.orgwww.compassionandsupport.org National Hospice and Palliative Care Organization www.nhpco.org National Hospice and Palliative Care Organization www.nhpco.orgwww.nhpco.org POLST resources www.polst.org POLST resources www.polst.orgwww.polst.org BOOKS BOOKS Dunn, Hank, Hard Choices for Loving People (www.hardchoices.com) Dunn, Hank, Hard Choices for Loving People (www.hardchoices.com)www.hardchoices.com Lynn, J., Harold, J., Handbook for Mortals (www.amazon.com) Lynn, J., Harold, J., Handbook for Mortals (www.amazon.com)

12. Questions?