Develop a policy on patient directives
Develop a policy on patient directives
Whether your same-day surgery program chooses to honor an advance directive or ask patients to waive the directives during their stay in your program, address the issue with a policy, says Mary L. Meyer, vice president of special projects for Choice in Dying in Washington, DC. Choice in Dying is a not-for-profit organization that helps patients and their families participate in decisions about end-of-life medical care.
This policy enables your staff to talk with patients who ask about development of a directive or placement of a directive in their chart.
"Your staff should be prepared to discuss advance directives and explain why in certain situations a patient can suspend the advance directive requests," says Meyer. "Also, be prepared to place the advance directive in the medical record and assure patients that if they are transferred to an acute care facility, the directive will go with them."
If you ask the patient to waive the advance directive, set a specific time frame that the directive will be suspended, such as only during surgery and post-anesthesia care, she says. This limitation will assure the patients that if something does happen and they have to be transferred to an acute care facility, the advance directive will be honored by the other facility.
Choice in Dying can serve as a resource for building information packets and provides a booklet that explains advance directives in simple terms and copies of advance directive forms for each state that can be downloaded for free from the Choice in Dying Web site, says Meyer. (For more information, see resource box, above right.) Pro-gram managers also can check with local hospitals or state departments that handle oversight of health care to obtain state-specific forms, she adds.
Although most same-day surgery staff don’t deal with patients who are ill or likely to suffer an untoward event during surgery, it is important to recognize that patients are concerned, says Meyer. "A policy that addresses advance directives and fully informs the patients is just one more way a same-day surgery program can be humanistic and address patient needs."
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