Advance Directives

Purpose:

The purpose of this policy is to provide an atmosphere of respect and caring and to ensure that each patient's ability and right to participate in medical decision making is maximized and not compromised as a result of admission for care through this facility. Additionally, the purpose of this policy is to assure compliance with the Patient Self-Determination Act (PSDA) in such a manner as to expand the patient, personnel and community knowledge base regarding advance directives and the process by which patient participation in medical decision making is carried out at this facility.

Policy:

• It is the policy of this facility to respect and encourage patient self-determination. Patients will be encouraged and assisted to be active participants in the decision making process regarding their care through education, inquiry and assistance as requested. Patients will be encouraged to communicate their desires in regard to advance directives to their significant others, to allow for guidance of significant others and healthcare providers in following the patient's wishes should the patient become incapacitated, rendering them unable to make decisions. The existence of an advance directive, or lack thereof, will not determine the patient’s access to care, treatment and services.
• It is important for the patient to be aware prior to signing the consent to operation, anesthesia, and other medical services; there may be a modification of their advance directive.
• If the patient has questions regarding modification or initiation of an advance directive they will be referred to either their physician, or anesthesiologist.
• The ASC will provide the patient or, as appropriate, the patient’s representative with information concerning its policies on advance directives prior to performing any procedure
• The patient will be provided information that includes a description of applicable state health and safety laws and, and official state advance directive forms if requested by using the following Department of Health Services website:
  http://www.dhs.wisconsin.gov/forms/advdirectives/index.htm
• This facility will honor Advance Directives, Health Care Proxies or Living Wills. The facility will discuss suspension of advance directives with patient and family due to the elective nature of cases performed. All efforts will be made to resuscitate patients and transfer them to a higher level of care in the event of an arrest or life threatening emergency.
• Advance Directives will be actively maintained if patient and family do not agree to suspend.

Procedure

• All patients will be provided with a copy of this policy in advance of their surgical procedure.
• All patients will be questioned about advanced directives during the preoperative interview process. Any patients affirming that they have an existing advanced directive during the preoperative interview will be informed by the nurse of the facility policy regarding advanced directives.
• If a patient inquires or presents an Advance Directive upon admission, they will be informed and a progress note documented in the chart by the admitting physician regarding the options that would honor their advanced directives while allowing the organization to provide appropriate safe care to include suspension of advanced directive.
• All patients will be required to acknowledge the policy regarding suspension of advanced directives for cardiopulmonary resuscitation or other artificial life sustaining measures on the operative consent form.
• A copy of the Advance Directive, presented to the facility, will be placed on the patient’s chart. In the event of an emergency and/or transfer, the chart, inclusive of the Advance Directive, will be sent with the patient to a higher level of care, i.e. the hospital emergency room.

References:

Accreditation Handbook for Ambulatory Health Care, Chapter 1, Section B, 5 Rights of Patient, - 2018 Edition

Centers for Medicare & Medicaid services, HHS 42 CFR Ch. IV, §416.50 (c)(1) Patient Rights, - Standard: Advanced Directives

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