J2E EDUCATION SESSIONS

Size: px
Start display at page:

Download "J2E EDUCATION SESSIONS"

Transcription

1 August 18, 2014 J2E EDUCATION SESSIONS Attached is a revised agenda for the Aug and Sept , J2E Education Sessions. Front Line Staff and All Employees means all MVH employees. The early morning sessions have been changed from previous communications. The 6-7 a.m. session has been changed to 5:30-6:30 a.m. to better accommodate the midnight shift staff. Please post the corrected agendas and request that all staff attend the sessions. WHAT IS POLST? Ray Andrews, Vice President Administration and Support Services Pennsylvania Orders for Life-Sustaining Treatment (POLST) is information added to the Policy for Patient Self Determination (Administrative Policy 2-39) in the most recent revision. POLST is a system developed for improving the quality of patient care and reducing medical errors by identifying, communicating and respecting a patient s wishes with regard to medical treatment through portable medical orders. POLST is not for everyone. Only patients suffering from serious illness or frailty should complete a POLST form. For these patients, their current health status should demonstrate a need for a standing order for emergent or future medical care. Completion of a POLST form can be part of a patient s advance care planning. Advance care planning conversations occur between the physician and patient as well as those close to the patient. In these conversations, patients are informed of their treatment options. Decisions are made, based on personal beliefs and current state of health, as to treatments the patient does/does not want. For a POLST to be considered valid, it must contain the patient s name and signature, resuscitation orders and a physician signature. The form is printed on pulsar pink card stock (65 lb.) paper. For healthy patients, an advance directive is an appropriate tool in making their wishes for end-of-life care known. For Team MVH, the process starts at the time of patient registration. Each adult patient will be asked if he or she has executed an Advance Directive (Living Will, Mental Health Living Will, Durable Power of Attorney for Health care and/or Mental Health Power of Attorney or POLST) and asked to provide a copy for their medical record. Not complying with a patient's advanced directive can lead to more than non-compliance with Center for Medicare and Medicaid Services (CMS) and The Joint Commission. Non-compliance can mean a potential lawsuit with large penalties and fees. Recently, a patient won $16.5 million dollars when a hospital, not MVH, did not follow their advance directive. Please review Administrative Policy 2-39 Patient Self Determination for details of the implementation of advanced directives, including POLST. If you or a patient have additional questions related to advance directives, or would like assistance in creating one, please contact me at ext UPDATE FOR MANDATED REPORTERS: CHILD ABUSE EDUCATION AND TRAINING REQUIREMENT Renee Hurley, M.Ed., L.P.C., Director of Patient Relations The Pennsylvania Family Support Alliance will provide three additional sessions to help our staff meet the training requirement necessary for re-licensure, certification and or registration. Staff may register via Net Learning for these classes. There is no guarantee that the Pennsylvania Family Support Alliance will provide additional opportunities for us. It is important that staff take advantage of these available opportunities. Staff members who do not take advantage of the classes offered will have to secure the training on their own at their own expense. Also, we must meet the minimum class enrollment in order to receive a refund on our deposit. Class enrollment also helps us when requesting additional classes. Please do not sign up and then fail to show. This could compromise future programs and refunds. The refunds help us to pay for additional classes. If you find that you cannot attend a session that you have registered for, please find a replacement. Classes will be offered from 9 a.m. to noon in the ECC on Oct. 21, Nov. 14 and Dec. 12. You must stay for the three-hour class in order to receive credit. If you have questions call me at ext Paula Bassi, Director of Staff Education Next issue s deadline: Wednesday, August 20, at noon. Send submissions to whurley@monvalleyhospital.com. Remove by Monday, August 25.

2 A G E N D A J2E Education Session August 25, 2014 Anthony M. Lombardi Education Conference Center LEADER S BACK TO BASICS Beverly Begovich - Presentor 10 a.m. 11:30 a.m. LEADERSHIP SESSION Focus is on the Leader s Role with RELATE, Words that Work, Hourly Rounding, and Discharge Telephone Calls 1:30 p.m. to 2:30 p.m. ALL EMPLOYEES 3 p.m. to 4 p.m. ALL EMPLOYEES 4:30 p.m. to 5:30 p.m. ALL EMPLOYEES 6 p.m. to 7 p.m. HOSPITALIST GROUP MD Communication (HCAHPS Domain)

3 A G E N D A J2E Education Session August 26, 2014 Anthony M. Lombardi Education Conference Center LEADER S BACK TO BASICS Beverly Begovich - Presentor 5:30 a.m. to 6:30 a.m. ALL EMPLOYEES 7:30 a.m. to 8:30 a.m. ALL EMPLOYEES 9 a.m. to 10 a.m. ALL EMPLOYEES 10:30 a.m. to 11:30 a.m. ALL EMPLOYEES 2 p.m. to 3 p.m. ALL EMPLOYEES

4 A G E N D A J2E Education Session September 22, 2014 Anthony M. Lombardi Education Conference Center Jesus Ramirez - Presentor 7:30 a.m. to 8:30 a.m. ALL EMPLOYEES 9 a.m. to 10 a.m. ALL EMPLOYEES 3 p.m. to 4 p.m. ALL EMPLOYEES 4:30 p.m. to 5:30 p.m. ALL EMPLOYEES 6 p.m. to 7 p.m. ALL EMPLOYEES

5 A G E N D A J2E Education Session September 23, 2014 Anthony M. Lombardi Education Conference Center Jesus Ramirez - Presentor 5:30 a.m. to 6:30 a.m. ALL EMPLOYEES 7:30 a.m. to 8:30 a.m. ALL EMPLOYEES 9 a.m. to 10 a.m. ALL EMPLOYEES 10:30 a.m. to 11:30 a.m. ALL EMPLOYEES 2 p.m. to 3 p.m. ALL EMPLOYEES

6 SEND FORM WITH PERSON WHENEVER TRANSFERRED OR DISCHARGED To follow these orders, an EMS provider must have an order from his/her medical command physician as, ame pennsylvania DEPARTMENT OF HEALTH Pennsylvania Orders for Life-Sustaining Treatment (POLST) First/Middle Initial Date of Birth FIRST follow these orders, THEN contact physician, certified registered nurse practitioner or physician assistant. This is an Order Sheet based on the person's medical condition and wishes at the time the orders were issued. Everyone shall be treated with dignity and respect. A CARDIOPULMONARY RESUSCITATION (CPR): Person has no pulse and is not breathing. CPR/Attempt Resuscitation 7 DNR/Do Not Attempt Resuscitation When not in cardiopulmonary arrest, follow orders in B, C and D. (Allow Natural Death) MEDICAL INTERVENTIONS: Person has pulse and/or is breathing. COMFORT MEASURES ONLY Use medication by any route, positioning, wound care and other measures to relieve pain and suffering. Use oxygen, oral suction and manual treatment of airway obstruction as needed for comfort. Do not transfer to hospital for life-sustaining treatment. Transfer if comfort needs cannot be met in current location. B LIMITED ADDITIONAL INTERVENTIONS Includes care described above. Use medical treatment, IV fluids and cardiac monitor as indicated. Do not use intubation, advanced airway interventions, or mechanical ventilation. Transfer to hospital if indicated. Avoid intensive care if possible. Li FULL TREATMENT Includes care described ventilation, and cardioversion as indicated. Transfer to hospital if indicated. Includes intensive care. above. Use intubation, advanced airway interventions, mechanical Additional Orders C ANTIBIOTICS: No antibiotics. Use other measures to relieve symptoms. Determine use or limitation of antibiotics when infection occurs, with comfort as goal Use antibiotics if life can be prolonged D ARTIFICIALLY ADMINISTERED HYDRATION / NUTRITION: Always offer food and liquids by mouth if feasible No hydration and artificial nutrition by tube. Trial period of artificial hydration and nutrition by tube. Long-term artificial hydration and nutrition by tube. Additional Orders Additional Orders E SUMMARY OF GOALS, MEDICAL CONDITION AND SIGNATURES: Patient Goals/Medical Condition: Discussed with Patient Parent of Minor Health Care Agent Health Care Representative Court-Appointed Guardian Other: By signing this form, I acknowledge that this request regarding resuscitative measures is consistent with the known desires of, and in the best interest of, the individual who is the subject of the form. Physician IPA/L.RNP Printed Name: Physician /PA/C.KNP Phone Number Physician/PA/LI-MP Signature (Required): DATE Signature of Patient or Surrogate Signature (required) Name (print) Relationship (write "sear it patient) PaDON version U 1 of 2

7 Other Contact Information SEND FORM WITH PERSON WHENEVER TRANSFERRED OR DISCHARGED Surrogate Kelatonstip Hbone Number Health Gare Hrotessional Prepanng Form Hreparer I tie Phone Number Date Freparea Directions for Healthcare Professionals Any individual for whom a Pennsylvania Order for Life-Sustaining Treatment form is completed should ideally have an advance health care directive that provides instructions for the individual's health care and appoints an agent to make medical decisions whenever the patient is unable to make or communicate a healthcare decision. If the patient wants a DNR Order issued in section "A", the physician/pa/crnp should discuss the issuance of an Out-of-Hospital DNR order, if the individual is eligible, to assure that an EMS provider can honor his/her wishes. Contact the Pennsylvania Department of Aging for information about sample forms for advance health care directives. Contact the Pennsylvania Department of Health, Bureau of EMS, for information about Out-of Hospital Do-Not-Resuscitate orders, bracelets and necklaces. POLST forms may be obtained online from the Pennsylvania Department of Health. Completing POLST Must be completed by a health care professional based on patient preferences and medical indications or decisions by the patient or a surrogate. This document refers to the person for whom the orders are issued as the "individual" or "patient" and refers to any other person authorized to make healthcare decisions for the patient covered by this document as the "surrogate." At the time a POLST is completed, any current advance directive, if available, must be reviewed. Must be signed by a physician/pa/crnp and patient/surrogate to be valid. Verbal orders are acceptable with followup signature by physician/pa/crnp in accordance with facility/community policy. A person designated by the patient or surrogate may document the patient's or surrogate's agreement. Use of original form is strongly encouraged. Photocopies and Faxes of signed POLST forms should be respected where necessary Using POLST Review If a person's condition changes and POLST is updated as appropriate. If any section is not completed, then treatment. An automated external defibrillator Resuscitation" Oral fluids and nutrition must always time permits, the patient or surrogate the healthcare provider should follow other appropriate methods to determine (AED) should not be used on a person who has chosen "Do Not Attempt be offered if medically feasible. must be contacted to assure that the When comfort cannot be achieved in the current setting, the person, including someone with "comfort measures only," should be transferred to a setting able to provide comfort (e.g., treatment of a hip fracture). A person who chooses either "comfort measures only" or "limited additional interventions" may not require transfer or referral to a facility with a higher level of care. An IV medication to enhance comfort may be appropriate for a person who has chosen "Comfort Measures Only." Treatment of dehydration is a measure which may prolong life. A person who desires IV fluids should indicate "Limited Additional Interventions" or "Full Treatment. A patient with or without capacity or the surrogate who gave consent to this order or who is otherwise specifically authorized to do so, can revoke consent to any part of this order providing for the withholding or withdrawal of lifesustaining treatment, at any time, and request alternative treatment. This form should be reviewed periodically (consider at least annually) and a new form completed if necessary when: (1) The person is transferred from one care setting or care level to another, or (2) There is a substantial change in the person's health status, or (3) The person's treatment preferences change. Revoking POLST If the POLST becomes invalid or is replaced by an updated version, draw a line through sections A through E of the invalid POLST, write "VOID" in large letters across the form, and sign and date the form. version 2 of 2

8

9 Department of Education Attendance Record Class Topic: At The Helm Class Date: August 18, 2014 Instructor/Presenter: Department: Coordinated by: Date sent to Education: Last Name Start Time: First Name Location of class: End time: Educational Format: (please select all that apply) Live program On-line Webinar Video Magazine Article Demonstration Other: ***Attendees must sign in to receive proper credit for this activity*** Signature Department Job Title 13 Please send supporting documentation: copies of program materials, certificates of completion, handouts, etc. along with attendance record(s) to the Education Dept. - Thank you! THIS AREA TO BE COMPLETED BY NETLEARNING ADMINISTRATORS ONLY Curriculum: Course Group: Class ID: Notes: C Format required: Yes or No C Format completed: Yes or No Date & Initial Recorded into NLA: Date Received :

Advance Directives The Patient s Right To Decide CH Oct. 2013

Advance Directives The Patient s Right To Decide CH Oct. 2013 Advance Directives The Patient s Right To Decide CH80850040 Oct. 2013 Advance Directives Your Right To Make Health Care Decisions Under The Law In Tennessee Tennessee and federal law give every competent

More information

Supersedes/Updates: 99-10

Supersedes/Updates: 99-10 No. 08-07 New York State Department of Health Bureau of Emergency Medical Services POLICY STATEMENT Supersedes/Updates: 99-10 November 20, 2008 Re: Medical Orders for Life Sustaining Treatment (MOLST)

More information

NEW YORK STATE DEPARTMENT OF HEALTH Medical Orders for Life Sustaining Treatment (MOLST) THE PATIENT KEEPS THE ORIGINAL MOLST FORM DURING TRAVEL TO DIFFERENT CARE SETTINGS. THE PHYSICIAN KEEPS A COPY.

More information

LOUISIANA ADVANCE DIRECTIVES

LOUISIANA ADVANCE DIRECTIVES LOUISIANA ADVANCE DIRECTIVES Legal Documents that Ensure that Your Choices for Future Medical Care or the Refusal of Same are Honored and Implemented by Your Health Care Providers Peoples Health is a Medicare

More information

Using the MOST Form Guidance for Health Care Professionals

Using the MOST Form Guidance for Health Care Professionals Updated 12.30.14 Using the MOST Form Guidance for Health Care Professionals Introduction and Overview According to the ethical principle of respect for patient autonomy and the legal principle of patient

More information

Oregon POLST Registry FACT SHEET

Oregon POLST Registry FACT SHEET FACT SHEET January 2015 OREGON AT A GLANCE ESTABLISHING THE REGISTRY Population (2013) 3.93 million Number of deaths (2013) 33,931 Number of hospitals 58 Number of nursing homes 136* Emergency Medical

More information

Facing Serious Illness: Make Your Wishes Known to your Health Care Professional

Facing Serious Illness: Make Your Wishes Known to your Health Care Professional Facing Serious Illness: Make Your Wishes Known to your Health Care Professional Your Guide to the Oregon POLST Program Physician Orders for Life-Sustaining Treatment Revised: February 19, 2015 This material

More information

The Law. What is an Advanced Healthcare Directives 9/2/2016. Presented by, Ruthann McFadden, LCSW-C Director of Social Services

The Law. What is an Advanced Healthcare Directives 9/2/2016. Presented by, Ruthann McFadden, LCSW-C Director of Social Services Presented by, Ruthann McFadden, LCSW-C Director of Social Services 1 The Law In 2006, Act 169 was signed into law. The purpose of the act was to provide a comprehensive statutory framework governing Advanced

More information

Guidance for Oregon s Health Care Professionals

Guidance for Oregon s Health Care Professionals Guidance for Oregon s Health Care Professionals www.or.polst.org Revised February 19, 2015 Table of Contents Introduction 1 Who Should Have a POLST Form... 2 How Advance Directives and POLST Work Together...

More information

INFORMATION ABOUT HEALTH CARE DECISONS. Health Care Proxy MOLST DNR

INFORMATION ABOUT HEALTH CARE DECISONS. Health Care Proxy MOLST DNR INFORMATION ABOUT HEALTH CARE DECISONS Health Care Proxy MOLST DNR February/2017 1 Introduction This informational booklet describing different options and procedures for making health care decisions was

More information

USING THE POST * FORM Guidance for Healthcare Professionals

USING THE POST * FORM Guidance for Healthcare Professionals USING THE POST * FORM Guidance for Healthcare Professionals 2012 Edition *Physician Orders for Scope of Treatment WV Center for End-of-Life Care 1.877.209.8086 www.wvendoflife.org CONTENTS USING the WV

More information

Deciding About. Health Care A GUIDE FOR PATIENTS AND FAMILIES. New York State Department of Health

Deciding About. Health Care A GUIDE FOR PATIENTS AND FAMILIES. New York State Department of Health Deciding About Health Care A GUIDE FOR PATIENTS AND FAMILIES New York State Department of Health 2 Introduction Who should read this guide? This guide is for New York State patients and for those who will

More information

Missouri Outside the Hospital Do Not Resuscitate Order. Boone County Fire Protection District EMS Education

Missouri Outside the Hospital Do Not Resuscitate Order. Boone County Fire Protection District EMS Education Missouri Outside the Hospital Do Not Resuscitate Order 4 Times to Withhold CPR Obviously mortal wound such as decapitation Rigor mortis Livor mortis also known as dependent lividity or venous pooling Valid

More information

Frequently Asked Questions for DNR

Frequently Asked Questions for DNR Frequently Asked Questions for DNR Q: What is Out-of-Hospital Do-Not-Resuscitate Order? A: An order that allows patients to direct health care professionals in the out-of-hospital setting to withhold or

More information

A Personal Decision. Illinois State Medical Society. Practical Information About Determining Your Future Medical Care.

A Personal Decision. Illinois State Medical Society. Practical Information About Determining Your Future Medical Care. A Personal Decision 2016 EDITION Practical Information About Determining Your Future Medical Care Living wills Powers of attorney for health care Mental health treatment preference declarations Uniform

More information

USING THE POST FORM GUIDANCE FOR HEALTHCARE PROFESSIONALS. Understanding Your Choices - Making Them Known Edition

USING THE POST FORM GUIDANCE FOR HEALTHCARE PROFESSIONALS. Understanding Your Choices - Making Them Known Edition USING THE POST FORM GUIDANCE FOR HEALTHCARE PROFESSIONALS 2016 Edition Understanding Your Choices - Making Them Known WV Center for End-of-Life Care Phone: 877-209-8086 www.wvendoflife.org CONTENTS USING

More information

DNR orders are used both in hospitals and in situations where a person might require emergency care outside of the hospital.

DNR orders are used both in hospitals and in situations where a person might require emergency care outside of the hospital. Advance Directives Summary Although Advance Directives can take many forms, there are two main types of advance directive the Living Will and the Durable Power of Attorney for Health Care. Mercy s policy

More information

STATE BOARD OF HEALTH ADMINISTRATIVE CODE CHAPTER ADVANCE DIRECTIVES TABLE OF CONTENTS

STATE BOARD OF HEALTH ADMINISTRATIVE CODE CHAPTER ADVANCE DIRECTIVES TABLE OF CONTENTS Health Chapter 420-5-19 STATE BOARD OF HEALTH ADMINISTRATIVE CODE CHAPTER 420-5-19 ADVANCE DIRECTIVES TABLE OF CONTENTS 420-5-19-.01 Advance Directives 420-5-19-.02 Portable Physician Do Not Attempt Resuscitation

More information

Advance Directives. Planning Ahead For Your Healthcare

Advance Directives. Planning Ahead For Your Healthcare Advance Directives Planning Ahead For Your Healthcare Core Values Catholic Health Initiatives core values of Reverence, Integrity, Compassion, and Excellence are the guiding principles that provide focus,

More information

NEBRASKA Advance Directive Planning for Important Healthcare Decisions

NEBRASKA Advance Directive Planning for Important Healthcare Decisions NEBRASKA Advance Directive Planning for Important Healthcare Decisions Caring Connections 1731 King St., Suite 100, Alexandria, VA 22314 www.caringinfo.org 800/658-8898 Caring Connections, a program of

More information

Authorized Durable Do Not Resuscitate Order Form & Instructions

Authorized Durable Do Not Resuscitate Order Form & Instructions Authorized Durable Do Not Resuscitate Order Form & Instructions Purpose The Durable Do Not Resuscitate (DDNR) Order and its regulations have been developed to carry out the intent of applicable Virginia

More information

WYOMING Advance Directive Planning for Important Healthcare Decisions

WYOMING Advance Directive Planning for Important Healthcare Decisions WYOMING Advance Directive Planning for Important Healthcare Decisions Caring Connections 1731 King St., Suite 100, Alexandria, VA 22314 www.caringinfo.org 800/658-8898 CARING CONNECTIONS Caring Connections,

More information

Maryland MOLST for the Health Care Practitioner. Maryland MOLST Training Task Force July 2013

Maryland MOLST for the Health Care Practitioner. Maryland MOLST Training Task Force July 2013 Maryland MOLST for the Health Care Practitioner Maryland MOLST Training Task Force July 2013 What is the Health Care Decisions Act? Health Care Decisions Act Applies in all health care settings and in

More information

L e g a l I s s u e s i n H e a l t h C a r e

L e g a l I s s u e s i n H e a l t h C a r e Page 1 L e g a l I s s u e s i n H e a l t h C a r e Tutorial #6 January 2008 Introduction Patients have the right to accept or refuse health care treatment. For a patient to exercise that right, he or

More information

YOUR RIGHT TO DECIDE YOUR RIGHT TO DECIDE YOUR RIGHT TO DECIDE

YOUR RIGHT TO DECIDE YOUR RIGHT TO DECIDE YOUR RIGHT TO DECIDE YOUR RIGHT TO DECIDE YOUR RIGHT TO DECIDE YOUR RIGHT TO DECIDE YOUR RIGHT TO DECIDE Communicating Your Health Care Choices In 1990, Congress passed the Patient Self-Determination Introduction Act. It requires

More information

As Passed by the Senate. Regular Session Sub. S. B. No

As Passed by the Senate. Regular Session Sub. S. B. No 131st General Assembly Regular Session Sub. S. B. No. 165 2015-2016 Senator Lehner Cosponsors: Senators Seitz, Jones, Skindell, Coley, Brown, Burke, Eklund, Hackett, Patton, Sawyer, Tavares A B I L L To

More information

COLORADO Advance Directive Planning for Important Healthcare Decisions

COLORADO Advance Directive Planning for Important Healthcare Decisions COLORADO Advance Directive Planning for Important Healthcare Decisions Caring Connections 1700 Diagonal Road, Suite 625, Alexandria, VA 22314 www.caringinfo.org 800/658-8898 Caring Connections, a program

More information

POLST Cue Card. If you die a natural death, would you want us to try CPR? If yes Requires Full Treatment in Section B. (Ask about Ventilator Trial)

POLST Cue Card. If you die a natural death, would you want us to try CPR? If yes Requires Full Treatment in Section B. (Ask about Ventilator Trial) POLST Cue Card It s important to talk about your health and your wishes for medical care if you got really sick. We talk about this with everyone with serious illness. Your doctor will review what we talk

More information

PHYSICIAN S GUIDELINES FOR WRITING DO NOT RESUSCITATE ORDERS

PHYSICIAN S GUIDELINES FOR WRITING DO NOT RESUSCITATE ORDERS PHYSICIAN S GUIDELINES FOR WRITING DO NOT RESUSCITATE ORDERS THE PURPOSE OF CPR IS THE PREVENTION OF SUDDEN UNEXPECTED DEATH. CPR IS NOT INDICATED IN CERTAIN SITUATIONS SUCH AS CASES OF TERMINAL IRREVERSIBLE

More information

MASSACHUSETTS Advance Directive Planning for Important Healthcare Decisions

MASSACHUSETTS Advance Directive Planning for Important Healthcare Decisions MASSACHUSETTS Advance Directive Planning for Important Healthcare Decisions Caring Connections 1700 Diagonal Road, Suite 625, Alexandria, VA 22314 www.caringinfo.org 800/658-8898 Caring Connections, a

More information

vv POLST for Hospice Providers

vv POLST for Hospice Providers vv. 2.2.17 POLST for Hospice Providers Permission to Use This slide presentation may be used without permission. To promote consistency across the state, the slides may not be altered. You may freely take

More information

Ambulatory Surgery Center Patient Consent to Resuscitative Measures

Ambulatory Surgery Center Patient Consent to Resuscitative Measures Ambulatory Surgery Center Patient Consent to Resuscitative Measures Not a Revocation of Advance Directives or Medical Power Of Attorney All patients have the right to participate in their own health care

More information

TheValues History: A Worksheet for Advance Directives Courtesy of Somerset Hospital s Ethics Committee

TheValues History: A Worksheet for Advance Directives Courtesy of Somerset Hospital s Ethics Committee TheValues History: A Worksheet for Advance Directives Courtesy of Somerset Hospital s Ethics Committee Advance Directives Living Wills Power of Attorney The Values History: A Worksheet for Advanced Directives

More information

Colorado CPR Directives. Colorado Department of Public Health and Environment Emergency Medical and Trauma Services Section

Colorado CPR Directives. Colorado Department of Public Health and Environment Emergency Medical and Trauma Services Section Colorado CPR Directives Colorado Department of Public Health and Environment Emergency Medical and Trauma Services Section Course Objectives Upon completion of this class, you should be able to: Identify

More information

NO TALLAHASSEE, June 30, Mental Health/Substance Abuse

NO TALLAHASSEE, June 30, Mental Health/Substance Abuse CFOP 155-52 STATE OF FLORIDA DEPARTMENT OF CF OPERATING PROCEDURE CHILDREN AND FAMILIES NO. 155-52 TALLAHASSEE, June 30, 2017 Mental Health/Substance Abuse USE OF DO NOT RESUSCITATE (DNR) ORDERS IN STATE

More information

Goals & Objectives 4/17/2014 UNDERSTANDING ADVANCE HEALTH CARE DIRECTIVES (AHCD) By Maureen Kroning, EdD, RN. Why would someone need to do this?

Goals & Objectives 4/17/2014 UNDERSTANDING ADVANCE HEALTH CARE DIRECTIVES (AHCD) By Maureen Kroning, EdD, RN. Why would someone need to do this? UNDERSTANDING ADVANCE HEALTH CARE DIRECTIVES (AHCD) By Maureen Kroning, EdD, RN Goals & Objectives Participants will increase their knowledge about AHCD Review AHCD documents used at the hospital Role

More information

Interpretive Guidelines (b)(2) Interpretive Guidelines (b)(3)

Interpretive Guidelines (b)(2) Interpretive Guidelines (b)(3) F153 483.10(b)(2) Interpretive Guidelines 483.10(b)(2) The resident or his or her legal representative has the right (i) Upon an oral or written request, to access all records pertaining to himself or

More information

Advance [Health Care] Directive

Advance [Health Care] Directive Advance [Health Care] Directive Introduction I have completed this Advance Directive with much thought. This document gives my treatment choices and preferences, and/or appoints a Health Care Agent (also

More information

PENNSYLVANIA Advance Directive Planning for Important Healthcare Decisions

PENNSYLVANIA Advance Directive Planning for Important Healthcare Decisions PENNSYLVANIA Advance Directive Planning for Important Healthcare Decisions Caring Connections 1731 King St., Suite 100, Alexandria, VA 22314 www.caringinfo.org 800/658-8898 Caring Connections, a program

More information

VIRGINIA Advance Directive Planning for Important Health Care Decisions

VIRGINIA Advance Directive Planning for Important Health Care Decisions VIRGINIA Advance Directive Planning for Important Health Care Decisions Caring Connections 1731 King St., Suite 100, Alexandria, VA 22314 www.caringinfo.org 800/658-8898 CARING CONNECTIONS Caring Connections,

More information

2

2 1 2 3 4 Designation of Health Care Surrogate I, (please print) want Phone Address to be my Health Care Surrogate and make health care decisions for me as indicated by my initials below: Effective only

More information

MY ADVANCE CARE PLANNING GUIDE

MY ADVANCE CARE PLANNING GUIDE MY DVNCE CRE PLNNING GUIDE Let s TLK! Tell us your values and beliefs about your healthcare. Take time to have the conversation with your physician and your family. lways be open and honest. Leave no doubt

More information

GEORGIA ADVANCE DIRECTIVE FOR HEALTH CARE

GEORGIA ADVANCE DIRECTIVE FOR HEALTH CARE GEORGIA ADVANCE DIRECTIVE FOR HEALTH CARE By: Date of Birth: (Print Name) (Month/Day/Year) This advance directive for health care has four parts: PART ONE HEALTH CARE AGENT. This part allows you to choose

More information

State of Ohio Health Care Power of Attorney of

State of Ohio Health Care Power of Attorney of Page1 State of Ohio Health Care Power of Attorney of (Print Full Name) (Birth Date) I state that this is my Health Care Power of Attorney and I revoke any prior Health Care Power of Attorney signed by

More information

Adult: Any person eighteen years of age or older, or emancipated minor.

Adult: Any person eighteen years of age or older, or emancipated minor. Advance Directives Policy and Procedure Purpose 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

More information

ADVANCE DIRECTIVE INFORMATION

ADVANCE DIRECTIVE INFORMATION ADVANCE DIRECTIVE INFORMATION NOTE: This Advance Directive Information and the form Living Will and Durable Power of Attorney for Health Care on the Arkansas Bar Association s website are being provided

More information

OREGON Advance Directive Planning for Important Healthcare Decisions

OREGON Advance Directive Planning for Important Healthcare Decisions OREGON Advance Directive Planning for Important Healthcare Decisions Caring Connections 1700 Diagonal Road, Suite 625, Alexandria, VA 22314 www.caringinfo.org 800/658-8898 Caring Connections, a program

More information

Patient Self-Determination Act

Patient Self-Determination Act Holy Redeemer Hospital Patient Self-Determination Act NOTES:: MAKING YOUR OWN HEALTH CARE DECISIONS: As a competent adult, you have the fundamental right, in collaboration with your health care providers,

More information

ALLINA HOME & COMMUNITY SERVICES ALLINA HEALTH. Advance Care Planning. Discussion guide. Discussion Guide. Advance care planning

ALLINA HOME & COMMUNITY SERVICES ALLINA HEALTH. Advance Care Planning. Discussion guide. Discussion Guide. Advance care planning ALLINA HOME & COMMUNITY SERVICES ALLINA HEALTH Advance Care Planning Discussion guide Discussion Guide Advance care planning Advance care planning Any of us could think of a time when we might be too sick

More information

MY ADVANCE CARE PLANNING GUIDE

MY ADVANCE CARE PLANNING GUIDE MY DVNCE CRE PLNNING GUIDE Let s TLK! Tell us your values and beliefs about your healthcare. Take time to have the conversation with your physician and your family. lways be open and honest. Leave no doubt

More information

POLST Discussions Doing it Better. Clinical Update in Geriatric Medicine. Judith S. Black, MD, MHA. POLST Overview. Faculty Disclosure PART I

POLST Discussions Doing it Better. Clinical Update in Geriatric Medicine. Judith S. Black, MD, MHA. POLST Overview. Faculty Disclosure PART I Faculty Disclosure POLST Discussions Doing it Better Clinical Update in Geriatric Medicine Dr. Black discloses that she is employed by Allegheny Health Network and is an executive committee member of the

More information

Advance Directives. Important information on health care decision-making: You Have the Right to Decide

Advance Directives. Important information on health care decision-making: You Have the Right to Decide Advance Directives Important information on health care decision-making: You Have the Right to Decide The documents provided in this package are being presented to you in accordance with the Federal Patient

More information

Refuse or request life prolonging treatment Refuse or request artificial feeding or hydration Express your wishes regarding organ donation

Refuse or request life prolonging treatment Refuse or request artificial feeding or hydration Express your wishes regarding organ donation The following contains information on Advance Directives: Your Right to Make Health Care Decisions Under the Law in Kentucky and will answer your questions and includes the legal form and instructions

More information

GEORGIA S ADVANCE DIRECTIVE FOR HEALTH CARE

GEORGIA S ADVANCE DIRECTIVE FOR HEALTH CARE GEORGIA S ADVANCE DIRECTIVE FOR HEALTH CARE The Georgia General Assembly has long recognized the right of individuals to control all aspects of their personal care and medical treatment, including the

More information

Georgia Advance Directive for Healthcare

Georgia Advance Directive for Healthcare Navicent Health Georgia Advance Directive for Healthcare GEORGIA ADVANCE DIRECTIVE FOR HEALTH CARE By: Date of Birth: (Print Name) (Month/Day/Year) PART ONE HEALTH CARE AGENT This part allows you to choose

More information

Advance Directive Form

Advance Directive Form Advance Directive Form NOTE: This form is being provided to you as a public service. The attached forms are provided as is and are not the substitute for the advice of an attorney. By providing these forms

More information

483.10(b)(4) and (8) Rights Regarding Advance Directives, Treatment, and Experimental Research

483.10(b)(4) and (8) Rights Regarding Advance Directives, Treatment, and Experimental Research 483.10(b)(4) and (8) Rights Regarding Advance Directives, Treatment, and Experimental Research (F155) Surveyor Training of Trainers: Interpretive Guidance Investigative Protocol Federal Regulatory Language

More information

Insert State Name Here

Insert State Name Here Request for Endorsement of State POLST Program State POLST Program: Insert State Name Here Directions: Please complete the information requested on this form and submit the form and additional information

More information

PENNSYLVANIA Advance Directive Planning for Important Health Care Decisions

PENNSYLVANIA Advance Directive Planning for Important Health Care Decisions PENNSYLVANIA Advance Directive Planning for Important Health Care Decisions Caring Connections 1731 King St., Suite 100, Alexandria, VA 22314 www.caringinfo.org 800/658-8898 Caring Connections, a program

More information

DURABLE HEALTH CARE POWER OF ATTORNEY AND HEALTH CARE TREATMENT INSTRUCTIONS (LIVING WILL) PART I INTRODUCTORY REMARKS ON HEALTH CARE DECISION MAKING

DURABLE HEALTH CARE POWER OF ATTORNEY AND HEALTH CARE TREATMENT INSTRUCTIONS (LIVING WILL) PART I INTRODUCTORY REMARKS ON HEALTH CARE DECISION MAKING DURABLE HEALTH CARE POWER OF ATTORNEY AND HEALTH CARE TREATMENT INSTRUCTIONS (LIVING WILL) PART I INTRODUCTORY REMARKS ON HEALTH CARE DECISION MAKING You have the right to decide the type of health care

More information

Portable Do Not Attempt Resuscitation Orders Amendments to the Alabama Natural Death Act

Portable Do Not Attempt Resuscitation Orders Amendments to the Alabama Natural Death Act Portable Do Not Attempt Resuscitation Orders 2016 Amendments to the Alabama Natural Death Act The Natural Death Act, Ala. Code22-8A-1 et seq., contains provisions that affirm the right of competent adult

More information

ADVANCE DIRECTIVE FOR HEALTH CARE

ADVANCE DIRECTIVE FOR HEALTH CARE ADVANCE DIRECTIVE FOR HEALTH CARE This document includes a list of definitions and the two types of Advance Directives (together called a Combined Directive). Some people choose to fill out only one portion.

More information

LOUISIANA ADVANCE DIRECTIVES

LOUISIANA ADVANCE DIRECTIVES LOUISIANA ADVANCE DIRECTIVES Legal Documents To Make Sure Your Choices for Future Medical Care or the Refusal of Same are Honored and Implemented by Your Health Care Providers ADVANCE DIRECTIVES INTRODUCTION

More information

Georgia Advance Directive for Health Care

Georgia Advance Directive for Health Care Georgia Advance Directive for Health Care By: (Print Name) Date of Birth: (Month/Day/Year) This advance directive for health care has four parts: PART ONE PART TWO PART THREE HEALTH CARE AGENT. This part

More information

Advance Care Planning. Ken Brummel-Smith, MD Charlotte Edwards Maguire Professor of Geriatrics FSU College of Medicine

Advance Care Planning. Ken Brummel-Smith, MD Charlotte Edwards Maguire Professor of Geriatrics FSU College of Medicine Advance Care Planning Ken Brummel-Smith, MD Charlotte Edwards Maguire Professor of Geriatrics FSU College of Medicine 1 Principles of Ethics Autonomy/Respect for Persons Beneficence Non- maleficence Justice

More information

Minnesota Health Care Directive Planning Toolkit

Minnesota Health Care Directive Planning Toolkit Minnesota Health Care Directive Planning Toolkit This planning toolkit contains information to help you: Plan Ahead Understand Common Terms Know the Facts Complete a Health Care Directive: Step-by-Step

More information

GEORGIA Advance Directive Planning for Important Health Care Decisions

GEORGIA Advance Directive Planning for Important Health Care Decisions GEORGIA Advance Directive Planning for Important Health Care Decisions CaringInfo 1731 King St., Suite 100, Alexandria, VA 22314 www.caringinfo.org 800/658-8898 CaringInfo, a program of the National Organization

More information

Outside the Hospital Do-Not-Resuscitate Order

Outside the Hospital Do-Not-Resuscitate Order Outside the Hospital Do-Not-Resuscitate Order This Act defines an Outside the Hospital Do-Not-Resuscitate Order and requires a copy of such an order be included as the first page of a patient's medical

More information

Advance Directives Information & Do Not Resuscitate Orders

Advance Directives Information & Do Not Resuscitate Orders Advance Directives Information & Do Not Resuscitate Orders summahealth.org Contents Information About Advance Directives 4 You Have a Choice 4 What are my rights in choosing my medical care? 5 What if

More information

NEW YORK STATE BAR ASSOCIATION. LEGALEase. Living Wills and Health Care Proxies

NEW YORK STATE BAR ASSOCIATION. LEGALEase. Living Wills and Health Care Proxies NEW YORK STATE BAR ASSOCIATION LEGALEase Living Wills and Health Care Proxies Introduction Today s advanced medical technology may result in the possibility of being subjected to various invasive medical

More information

The POLST Conversation POLST Script

The POLST Conversation POLST Script The POLST Conversation POLST Script The POLST Script provides detailed information in order to develop comfort and competence when facilitating a POLST conversation. The POLST conversation utilizes realistic

More information

MAKING YOUR WISHES KNOWN: Advance Care Planning Guide

MAKING YOUR WISHES KNOWN: Advance Care Planning Guide MAKING YOUR WISHES KNOWN: Advance Care Planning Guide ADVANCE CARE PLANNING The process of learning about the type of medical decisions that may need to be made, considering those decisions ahead of time

More information

FORM 1 Health care power of attorney PAGE 1

FORM 1 Health care power of attorney PAGE 1 FORM 1 Health care power of attorney PAGE 1 This form allows you, the principal, to name a person to make health care decisions for you if you are unable to do so. You should also name alternate agents

More information

SOUTH CAROLINA HEALTH CARE POWER OF ATTORNEY

SOUTH CAROLINA HEALTH CARE POWER OF ATTORNEY SOUTH CAROLINA HEALTH CARE POWER OF ATTORNEY INFORMATION ABOUT THIS DOCUMENT THIS IS AN IMPORTANT LEGAL DOCUMENT. BEFORE SIGNING THIS DOCUMENT, YOU SHOULD KNOW THESE IMPORTANT FACTS: 1. THIS DOCUMENT GIVES

More information

ILLINOIS Advance Directive Planning for Important Health Care Decisions

ILLINOIS Advance Directive Planning for Important Health Care Decisions ILLINOIS Advance Directive Planning for Important Health Care Decisions CaringInfo 1731 King St., Suite 100, Alexandria, VA 22314 www.caringinfo.org 800/658-8898 CaringInfo, a program of the National Hospice

More information

Physician s Order for Life Sustaining Treatment (POLST)

Physician s Order for Life Sustaining Treatment (POLST) Physician s Order for Life Sustaining Treatment (POLST) Vicki McNealley, PhD, MN, RN, Corporate Director of Quality Assurance for Village Concepts Chair WHCA Assisted Living Committee Elena Madrid, RN,

More information

Revised 2/27/17. POLST For General Providers

Revised 2/27/17. POLST For General Providers Revised 2/27/17 POLST For General Providers Permission to Use This slide presentation may be used without permission. To promote consistency across the state, the slides may not be altered. You may freely

More information

HealthStream Regulatory Script

HealthStream Regulatory Script HealthStream Regulatory Script Advance Directives Version: [May 2006] Lesson 1: Introduction Lesson 2: Advance Directives Lesson 3: Living Wills Lesson 4: Medical Power of Attorney Lesson 5: Other Advance

More information

Your Guide to Advance Directives

Your Guide to Advance Directives Starting Points: Your Guide to Advance Directives Values Statements Healthcare Directives Durable Power of Attorney for Healthcare 1 2 Advances in medicine are helping people to live longer than ever before.

More information

Advance Directives Living Will and Durable Power of Attorney for Health Care

Advance Directives Living Will and Durable Power of Attorney for Health Care Advance Directives Living Will and Durable Power of Attorney for Health Care St. Luke s and its physicians and staff believe in the basic principle of patient self-determination and the rights of competent

More information

Final Choices Faithful Care

Final Choices Faithful Care Final Choices Faithful Care A guide to important medical decisions and how to share them with those involved in your care. Mercy Health System is committed to providing care to our patients through all

More information

ADVANCE HEALTH CARE DIRECTIVE HEALTH CARE POWER OF ATTORNEY AND LIVING WILL

ADVANCE HEALTH CARE DIRECTIVE HEALTH CARE POWER OF ATTORNEY AND LIVING WILL ADVANCE HEALTH CARE DIRECTIVE A HEALTH CARE POWER OF ATTORNEY AND LIVING WILL INSIDE: LEGAL DOCUMENTS AND INSTRUCTIONS TO ASSIST YOU WITH IMPORTANT HEALTH CARE DECISIONS Health Care Decision Making Modern

More information

Patient Decision Making

Patient Decision Making Patient Decision Making Pennsylvania Coalition of Nurse Practitioners November 7, 2015 Objectives To identify the legal and ethical principles which form the basis for patient decision making; To understand

More information

ALASKA ADVANCE HEALTH CARE DIRECTIVE for Client

ALASKA ADVANCE HEALTH CARE DIRECTIVE for Client ALASKA ADVANCE HEALTH CARE DIRECTIVE for Client PART 1 DURABLE POWER OF ATTORNEY FOR HEALTH CARE DECISIONS (1) DESIGNATION OF AGENT. I designate the following individual as my agent to make health care

More information

Many who are interested in medicine, palliative care and hospice and bioethics have been

Many who are interested in medicine, palliative care and hospice and bioethics have been NEW "DNR" RULES WENT INTO EFFECT MAY 20, 1999 Many who are interested in medicine, palliative care and hospice and bioethics have been carefully following the progress of the legislation on "portable DNR"

More information

A PERSONAL DECISION

A PERSONAL DECISION A PERSONAL DECISION Practical information about determining your future medical care including declaration, powers of attorney for health care and organ donation Determining Your Medical Care is Your

More information

Your Right to Make Health Care Decisions in Colorado

Your Right to Make Health Care Decisions in Colorado Your Right to Make Health Care Decisions in Colorado This e-book informs you about your right to make health care decisions, including the right to accept or refuse medical treatment. It explains the following

More information

Sutton Place Behavioral Health, Inc. POLICY NO. CLM-19 EFFECTIVE DATE:

Sutton Place Behavioral Health, Inc. POLICY NO. CLM-19 EFFECTIVE DATE: Sutton Place Behavioral Health, Inc. POLICY NO. CLM-19 EFFECTIVE DATE: 03-17-04 HEALTH CARE ADVANCE DIRECTIVES ATTACHMENTS: Living Will Designation of Health Care Surrogate Wallet card Advance Directives

More information

OHIO Advance Directive Planning for Important Health Care Decisions

OHIO Advance Directive Planning for Important Health Care Decisions OHIO Advance Directive Planning for Important Health Care Decisions Caring Info 1731 King St., Suite 100, Alexandria, VA 22314 www.caringinfo.org 800/658-8898 Caring Info, a program of the National Organization

More information

What Are Advance Medical Directives?

What Are Advance Medical Directives? What Are Advance Medical Directives? UAMS would like you to know there are ways to let others know what decisions you would want to make about your medical treatments, even when you are unable to speak

More information

Process

Process www.theroyl.com Advance Directive And Durable Power Of Attorney Advance Medical Directive State of Virginia The Rest of Your Life recommends that you review completed documents with an attorney, especially

More information

DURABLE POWER OF ATTORNEY FOR HEALTH CARE (Rhode Island Version) You must be at least eighteen (18) years of age.

DURABLE POWER OF ATTORNEY FOR HEALTH CARE (Rhode Island Version) You must be at least eighteen (18) years of age. MASSASOIT INTERNAL MEDICINE (401) 434-2704 massasoitmed.com DURABLE POWER OF ATTORNEY FOR HEALTH CARE (Rhode Island Version) THE DURABLE POWER OF ATTORNEY FOR HEALTH CARE DOCUMENT lets you appoint someone

More information

Your Right to Make Health Care Decisions

Your Right to Make Health Care Decisions 42 P O Box 10600 Grand Junction, CO 81502-5600 Your Right to Make Health Care Decisions Advance Directives What is an Advance Directive? It is a type of written instruction about your health care to be

More information

VIRGINIA Advance Directive Planning for Important Health Care Decisions

VIRGINIA Advance Directive Planning for Important Health Care Decisions VIRGINIA Advance Directive Planning for Important Health Care Decisions Caring Info 1731 King St., Suite 100, Alexandria, VA 22314 www.caringinfo.org 800/658-8898 CARING INFO Caring Info, a program of

More information

A PATIENT S GUIDE TO UNDERSTANDING ADVANCE HEALTH CARE DIRECTIVES. By Maureen Kroning EdD, RN

A PATIENT S GUIDE TO UNDERSTANDING ADVANCE HEALTH CARE DIRECTIVES. By Maureen Kroning EdD, RN A PATIENT S GUIDE TO UNDERSTANDING ADVANCE HEALTH CARE DIRECTIVES By Maureen Kroning EdD, RN Dedication This handbook is dedicated to patients, families, communities and the nurses that touch their lives

More information

LIVING WILL AND ADVANCE DIRECTIVES. Exercise Your Right: Put Your Healthcare Decisions in Writing.

LIVING WILL AND ADVANCE DIRECTIVES. Exercise Your Right: Put Your Healthcare Decisions in Writing. LIVING WILL AND ADVANCE DIRECTIVES Exercise Your Right: Put Your Healthcare Decisions in Writing. Maryland Advance Directive A Message from the Maryland Attorney General Adults can decide for themselves

More information

ADVANCED HEALTH CARE DIRECTIVE OF LAWRENCE HALL JR.

ADVANCED HEALTH CARE DIRECTIVE OF LAWRENCE HALL JR. ADVANCED HEALTH CARE DIRECTIVE OF LAWRENCE HALL JR. Identification. I, Lawrence Hall Jr., being a competent adult of sound mind, having the capacity to make health care decisions, willfully and voluntarily

More information

MARYLAND ADVANCE DIRECTIVE PLANNING FOR FUTURE HEALTH CARE DECISIONS

MARYLAND ADVANCE DIRECTIVE PLANNING FOR FUTURE HEALTH CARE DECISIONS MARYLAND ADVANCE DIRECTIVE PLANNING FOR FUTURE HEALTH CARE DECISIONS A guide to Maryland Law on Health Care Decisions (Forms Included) State of Maryland Office of the Attorney General Dear Fellow Marylander:

More information

Advance Directives: What Are They and Why Are They Important? By: Dr. Denise Brandon

Advance Directives: What Are They and Why Are They Important? By: Dr. Denise Brandon Advance Directives: What Are They and Why Are They Important? By: Dr. Denise Brandon At a Glance: An Advance Directive provides a way for persons who are providing health care to you to know your wishes

More information

Maryland MOLST FAQs. Maryland MOLST Training Task Force

Maryland MOLST FAQs. Maryland MOLST Training Task Force Maryland MOLST FAQs Maryland MOLST Training Task Force October 2017 Frequently Asked Questions About Maryland MOLST What does MOLST stand for? MOLST is an acronym that stands for Medical Orders for Life-Sustaining

More information