Tehachapi Valley Healthcare District
POLICY: Advance Health Care Directives Policy / POLICY NUMBER: 101.20
Original/Rewrite: May 25, 2012
Originating Dept: Patient Access (Admitting)
Applies to Depts: Patient Access, Activities/Social Services and
Nursing

POLICY:

  • Tehachapi Valley Healthcare District respects and encourages patient self-determination. Patients are 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 by significant others and healthcare providers in following the patient's wishes should the patient become incapacitated, rendering them unable to make decisions.

Tehachapi Valley Healthcare District shall inform patients, or the patients/patient representatives of any limitations if the hospital cannot honor an advance directive on the basis of conscience.

A statement of limitation shall include, at a minimum:

Clarification of any difference between hospitalwide conscience objectives and those that may be raised by physicians

Identification of state legal authority permitting such an objection

Description of medical conditions or procedures affected by conscience objection

  • The existence of an advance directive, or lack thereof, will not determine the patient’s access to care, treatment and services.

Tehachapi Valley Healthcare District shall ensure compliance with state law regarding advance directives.

  • In an advance directive (or medical power of attorney), the patient may provide guidance as to his/her wishes in certain situations, or may delegate decision making to another individual as permitted by state law.
  • If such an individual has been selected by the patient, or if a person willing and able under applicable state law is available to make treatment decisions, relevant information should be provided to the representative so that informed healthcare decisions can be made for the patient.
  • However, as soon as the patient is able to be informed of his/her rights, this hospital shall provide that information to the patient.

The advance directive shall be maintained in the medical record.

Tehachapi Valley Healthcare District Hospital shall educate appropriate staff regarding advance directives.

PROCEDURE:

  • Adult patients, 18-years and older will be offered Advance Health Care Directive information and asked to sign the “Advance Health Care Directive Information” form, NSG 32.
  • Admission of adult inpatients, emergency patients, residents (swingbed) patients, and observation patients: The Patient Access staff during the admissions process of the patient, or if the patient is incapacitated, to the patient's significant other will review and complete the form titled, “Advance Health Care Directive Information” and provide a copy to the signer:
  1. If the patient has completed an Advance Health Care Directive the Patient Access staff will either:
  1. Place a copy of the document in the chart or
  2. Request the family/friend bring a copy of the document to the Hospital and
  3. Notify the Nursing Department of the need to follow-up regarding the AHCD to be brought in my family/friends.
  4. Update in the patient’s master patient index on Healthland to reflect the patient’s decision on Advance Health Care Directive.
  1. If the patient would like information regarding Advance Health Care Directives, provide a copy of the brochure, “Your Right to Make Decisions About Medical Treatment” – English and Spanish available on Policy Manager. The brochure is also available in other languages from The Pacific Center for Health Policy & Ethics,
  1. Advance Health Care Directive forms also available on Policy Manager.
  • In the event that the patient bypasses the routine admissions process due to nature or severity of illness, and is admitted directly to the patient care units, the responsibility to inquire about advance directives and provide necessary information as outlined above, will remain with the Patient Accent staff to follow-up with 24 hours.
  • Should the patient present as a repeat admission, with information obtained by the admitting group indicating there is an advance directive in the previous medical record, the nursing staff will have the responsibility to review the existing advance directive with the patient/significant other to validate its current status. The medical record from the previous admission containing the advance directive will be identified with a red divider labeled "advance directive".

REFERENCES:

  • Protection and Advocacy System (state specific)
  • National Alliance on Mental Illness (NAMI),
  • CMS Conditions of Participation 482.13(b)(2), Tag A-0049
  • Patient Self-Determination: Advanced Directives, POLST, and DNR, Nursing, 112.01.03.01

Disclaimer: Printed copies are not the official document. See on-line version. 1