ADVANCE DIRECTIVES

Mini Hanspal RN, BSN, CMSRN

WHAT IS ADVANCE CARE PLANNING

It is a regulatory requirement that we inquire about the presence

of an Advance Directive and offer assistance in completing one for

each inpatient admission.

At CMC, we are dedicated to providing assistance with the

documentation, storage, retrieval, and honoring of patients’ advance

care planning as it is essential for providing quality that reflects the

goals and values of our patients.

TERMINOLOGY

The most common document that can result from advance care

planning is the Advance Directive. Every adult should have an

advance directive, no matter if they are healthy or ill.

A patient with an advance directive has designated a person to be

their health care agent.

The purpose of an agent is to speak in the place of the patient

when the patient cannot speak them for themselves.

TERMINOLOGY

If there is no advance directive naming a healthcare agent, we use

California Consent law guidelines to determine the appropriate

surrogate decision maker.

It is best to allow a patient to name their surrogate decision maker.

If we don’t have one on record for an admission, one will be chosen

for the patient, if they lose the ability to make their own decision.

ASSESSING FOR ADVANCE DIRECTIVE

Nursing does not inquire about patient preference for code status.

This discussion is outside nursing scope of practice.

The provider is responsible to address code status with the patient

or their agent.

If a patient requests a code status other than “full code”, notify

the provider of their request and document the discussion.

ADVANCE CARE PLANNING DOCUMENTS

ACP wishes can be documented in different ways:

• Advance Directive -

• POLST

• Oral Directive

ORAL DIRECTIVE

A patient who has decision making capacity has the right to give

verbal statement about their medical care

If a patient expresses the desire to dictate an oral directive, the RN

must document the request in the patient’s chart and notify the

provider.

ORAL DIRECTIVE

If a patient wishes to give an oral directive on this admission,

select this and the provider will be alerted with a banner. In some

cases a call to the provider is appropriate.

Remember, the oral directive and code status discussion is the

responsibility of the provider.

ADVANCE CARE DOCUMENTS

Do not chart a document that you do not see.

If family agrees to bring a document, chart when you receive the

document.

ACP NAVIGATOR

RN ROLE:

Assess for existing documents on admission

Confirm available documents

Enter the appropriate document information

Do not chart a document unless you see it.

Document agent or surrogate information.

Update ACP navigator as new information is obtained.

QUESTIONS?