Date
of Last Review 4/8/08
SME: Director of Patient Services
UTHCPC is committed to the right of the patient to provide in advance for his/her
care in the event of a terminal, irreversible, or incapacitated condition.
It is the UTHCPC policy to provide written information to the adult inpatient upon admission, and assistance throughout their hospitalization, about the following:
 | Patient right to accept or refuse medical, surgical or psychiatric treatments |
| Patient right to formulate advance directives |
| Procedures respecting the implementation of those rights |
The following are definitions of terms referred to in this procedure:
Term |
Definition |
A terminal condition is one caused by injury, disease, or illness that according to reasonable medical judgement produces death within six months, even with available life-sustaining treatment. | |
An irreversible condition is a condition, injury, or illness that is treatable but incurable, that leaves a person unable to care for or make decisions for the person's own self; and that, without life-sustaining treatment, is fatal. | |
When the patient is no longer able to understand the nature of her/his illness or treatment options and cannot make health care decisions. |
The following table includes the types of advance directives along with their descriptions:
Advance Directives |
Description |
Directive to Physicians and Family or Surrogates (Living Will) |
A "Directive to Physicians" is an instruction to withhold or withdraw life-sustaining treatment. This directive may only be made by patients who have been diagnosed with a terminal or irreversible condition. Intent: The directive allows patients to tell their doctors whether and how to administer life-saving treatment. Policy for Implementation: UTHCPC is not equipped to provide advanced life-sustaining treatment. Patients who require such treatment are transferred to a medical facility. |
Out-of-Hospital Do Not Resuscitate (DNR) Order |
This is an instruction to health care professionals, including emergency medical technicians, in non-hospital settings. Health care providers are instructed not to use cardiopulmonary resuscitation (CPR) on patients who have fully and properly completed this document. Policy for Implementation: UTHCPC honors DNR orders, if and only if notice of the directive is provided. Notice may be in the form of a completed DNR form, or an officially recognized DNR identification device such as a bracelet or pendant. Exception: If a patient who has executed a DNR order, stops breathing under unnatural or suspicious circumstances, the DNR is automatically revoked and CPR is applied. |
Medical Power of Attorney |
This document allows a person (the "principal") to appoint someone else (an "agent") to make healthcare decisions for the principal in case s/he is unable. Policy for Implementation: UTHCPC abides by the principal's instructions in a medical power of attorney to the extent allowed by law. UTHCPC will make reasonable efforts to inform the principal of any proposed treatment or of any proposal to withdraw or withhold treatment before acting on an agent's advance directive. |
Mental Health Treatment Declaration |
This document allows an individual to direct her/his mental health care professionals in providing treatment once the patient is incapacitated. Policy for Implementation: If a patient is declared incapacitated or if a court issues an order for forced medication, UTHCPC makes every effort to adhere to the patient's declaration. Exception: UTHCPC reserves the right to ignore the declaration when the patient's or someone else's life is in danger and the patient's preferred treatment has been ineffective. |
Patient Registration role |
As part of the admission process, the patient who is not adjudged incapacitated receives specific information about advance directives from Patient Registration staff. |
Patient Registration staff assist the patient in completing Advance Directives Notification form:
Stage |
Description | ||||||
1 |
Introduces the advance directive notification process to each patient. | ||||||
2 |
Provides the patient with a copy of the patient guide that explains advance directives and information that outlines the patient rights to set an advance directive | ||||||
3 |
If the patient has an existing advance directives, attempts to locate the advance directives are as follows:
| ||||||
4 |
Checks the appropriate box on the advance directive form if the patient wishes or does not desire to initiate an advance directive and has patient sign and their witnesses |
This table describes the social services responsibilities:
Responsibility |
Description | ||||||
1 |
Reviews the current status of the advance directive identified by Patient Registration staff including patient's refusal to sign the form | ||||||
2 |
If necessary, provides ongoing educational information on advance directives to the patient/family and reemphasizes the information in the patient guide | ||||||
3 |
If the patient desires to initiate an advance directive, gives appropriate forms to the patient/family | ||||||
4 |
If the patient indicates that s/he has already completed an advance directive, reviews the patient's previous medical record to determine the inclusion of the advance directive. | ||||||
5 |
If the patient's existing advance directive has not yet been filed in the medical record, re-confirms the address specifying its location as documented by staff. | ||||||
6 |
If an advance directive exists at an external site and Patient Registration was unable to get a consent to release information, the social services worker has the patient fill it out and forwards it to Health Information Management. | ||||||
7 |
Encourages the patient/family to provide a copy of the advance directive. Once obtained, social services:
| ||||||
8 |
Documents the status of the patient's advance directive on the Advance Directive form for social services follow-up |
Patient Relations provides hospital units with the appropriate advance directives forms and any additional information on advance directives.
Nursing duties are as follows:
Responsibility |
Description |
1 |
Verifies the validity of the patient's advance directive |
2 |
If valid, notifies the attending physician and the treatment team |
3 |
Places the advance directive in the legal section of the medical record and places an "advance directives" sticker on the outside front cover of the chart |
If the attending physician does not want to follow the patient's advance directive then s/he must do the following:
Stage |
Description |
1 |
Makes a reasonable effort to transfer responsibility for the patient to another physician See: Withholding Resuscitation or Forgoing/Withholding Life-Sustaining Treatment |
2 |
Documents in the patient's chart the transfer and why it occurred |
3 |
Contacts Patient Relations for consultation |
The patient may revoke any advance directive at any time.
In addition, an Out-of-Hospital DNR may be revoked by the patient's:
| Legal guardian |
| Agent |
| Managing conservator |
| Qualified relative |
| Parent (if a minor) |
| Physician who executed the order |
The revocation may involve the communication of wishes to responding health care professionals or removal of any Do-Not-Resuscitate identification devices.
Nursing staff must write the word VOID on the Advance Directive Notification form and on the actual advance directive form. These documents should be kept in the legal section of the medical chart. Additionally, staff removes the sticker and notifies the attending physician and treatment team.
Related to regulatory standards
If you have questions regarding the content of this site please contact the Policy and Procedure Committee. If you experience any technical problems please contact the MIS Department.
