Advance Care Planning an introduc3on to the Brighton & Hove toolkit
|
|
- Mariah Hardy
- 6 years ago
- Views:
Transcription
1 Advance Care Planning an introduc3on to the Brighton & Hove toolkit Dr Simone Ali MA FRCP Clinical Director Macmillan Community Team Sussex Community NHS Trust and Consultant in Pallia3ve Medicine The Martlets Hospice, Hove Dr Louise Mason MSc MRCP Consultant in Pallia3ve Medicine Brighton & Sussex University Hospitals NHS Trust
2
3 Overview What is Advance Care Planning? How far have we come locally? The new Advance Care Planning Toolkit What it looks like Who should use it How to use it What difference could it make in prac3ce?
4 Advance Care Planning (ACP) A voluntary process of discussion and review between an individual and their care provider. To help an individual an3cipate how their condi3on may affect them in the future, and thus iden3fy the wishes and preferences of that individual regarding their future care. Helps guide care providers if needing to make decisions in the future should that individual lose capacity. Recommended that with the individual s consent, discussion is documented and communicated to key persons.
5 The differences between general care planning and decisions made in advance General Care Planning Advance Care Planning (ACP) - advance statement Advance Decisions to Refuse Treatment (ADRT) Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) What is covered? Can cover any aspect of current health and social care. Can cover any aspect of future health and social care. Can only cover refusal of specified future treatment. May be made as an option within an advance care planning discussion. Only covers decision about withholding future CPR. Who completes it? Can be written in discussion with the individual who has capacity for those decisions. or Can be completed for an individual who lacks capacity in their best interests. Is written by the individual who has capacity to make these statements. May be written with support from professionals, and relatives or carers. Cannot be written if the individual lacks capacity to make these statements. Is made by the individual who has capacity to make these decisions. May be made with support from a clinician. Cannot be made if an individual lacks capacity to make these decisions. Completed by a clinician with responsibility for the patient. Patient consent is sought only if an arrest is anticipated and CPR could be successful. Can be completed for an individual who does not have capacity if the decision is in their best interests. What does it provide? Provides a plan for current and continuing health and social care that contains achievable goals and the actions required. Covers an individual s preferences, wishes, beliefs and values about future care to guide future best interests decisions in the event an individual has lost capacity to make decisions. Only covers refusal of future specified treatments in the event that an individual has lost capacity to make those decisions. Documents either - that CPR cannot be successful and should not be attempted - an individual s advance decision to refuse CPR. Is it legally binding? No - advisory only. No - but must be taken into account when acting in an individual s best interests. Yes - legally binding if the ADRT is assessed as complying with the Mental Capacity Act and is valid and applicable. If it is binding it takes the place of best interests decisions about that treatment. Yes - if it is part of an ADRT. Otherwise it is advisory only, i.e. clinical judgement takes precedence. How does it help? Provides the multidisciplinary team with a plan of action. Makes the multidisciplinary team aware of an individual s wishes and preferences in the event that the patient loses capacity. If valid and applicable to current circumstances it provides legal and clinical instruction to multidisciplinary team. Makes it clear whether CPR should be withheld in the event of a cardiac or respiratory arrest. Does it need to be signed and witnessed? Does not need to be signed or witnessed. A signature is not a requirement, but its presence makes clear whose views are documented. For refusal of life sustaining treatment, it must be written, signed and witnessed and contain a statement that it applies even if the person s life is at risk. Does not need to be witnessed, but the usual practice is for the clinician to sign. Who should see it? The multidisciplinary team as an aid to care. Patient is supported in its distribution, but has the final say on who sees it. Patient is supported in its distribution, but has the final say on who sees it. Clinical staff who could initiate CPR in the event of an arrest.
6 Aims of ACP Purpose is to support pa3ent choice, and respect wishes of pa3ent and family Avoiding inappropriate interven3ons and hospital admissions at the end of life Allowing pa3ents to die in their place of choice
7 Why bother with ACP? Treatment and care towards the end of life: good practice in decision making you MUST plan ahead as much as possible to ensure 3mely access to safe, effec3ve care and con3nuity in its delivery to meet the pa3ent s need Guidance for doctors your conversa3ons should include
8 ACP might include discussions about... Prognosis Expected or poten3al clinical sequelae Care or treatment op3ons available Benefits and burdens of these Preferred place of care Wishes, beliefs, personal goals and aspira3ons
9 Do I act in my pa3ents best interests? Do I respect my patients' autonomy such that I am prepared to tell them the truth about their disease or prognosis and their realistic options, or do I continue to deceive both them and myself and waste their remaining life by behaving as though they will stay alive so long as I keep treating them? When looking at what may benefit them, do I ask them what good or bad looks like through their eyes, and seek to act upon it, or do I assume that I know best and carry on regardless? Professor Rob George. BMJ Support Palliat Care doi: /bmjspcare
10 Triggers for introducing ACP Significant change in health status Diagnosis of a chronic or progressive incurable illness Recogni3on of a likely life- limi3ng change Change in carer circumstances or change in care environment (e.g move to care home) Recogni3on of transi3on to terminal phase of an illness
11 Copyright 2008 BMJ Publishing Group Ltd. Murray, S. A et al. BMJ 2008;336: The three main trajectories of decline at the end of life
12 Introducing the ACP toolkit
13 LPA ADRT Advance Statement of Wishes & Preferences Preferred PrioriAes for Care (paaent held document) Planning your Future Care ADRT = Advance Decision to Refuse Treatment, LPA = Las3ng Power of Adorney
14 Name: Address: Advance Statement D.O.B NHS number: Clinical Issue Date N/A Details/Decision Preferred Place of Care Cardiopulmonary Resuscitation (CPR) Transfusion of Blood Products Clinically assisted Nutrition and Hydration Assisted Ventilation 1 st preference 2 nd preference If patient does not wish to receive CPR, has GP/Consultant signed a DNACPR form? The Martlets Hospice The Martlets Hospice Advance Care Planning process: Guidance for Health Care Professionals. This guidance has been developed by a range of professionals across the local health economy to assist you in documenting and sharing the discussions you have with patients when planning their future care and treatment, particularly if they may be living in the last year of their life. Advance Care Planning (ACP) is a voluntary process of discussion and review to help an individual who has capacity to anticipate how their condition may affect them in the future and, if they wish, set on record: choices about their care and treatment and/or an advance decision to refuse a treatment in specific circumstances, so that these can be referred to by those responsible for their care or treatment (whether professional staff or family carers) in the event that they lose capacity to decide once their illness progresses. If you are not familiar with ACP, we recommend you seek available educational opportunities locally and consult the following National End of Life Care Programme interactive document Capacity, care planning and advance care planning in life limiting illness : The diagram below illustrates the possible outcomes of an ACP discussion, with the areas proportional those who might receive/complete each. Not all need be completed and the top 3 layers can be completed in any order. Table 1 overleaf illustrates the relevant document with a brief explanation of what it is for. ADRT = Advance Decision to Refuse Treatment, LPA = Lasting Power of Attorney The steps to proceed with the ACP process: 1. Consider if you are the right person to have the conversation and if it is the right time? 2. Provide the patient with the Planning for your future care A Guide booklet 3. If this is the right time for ACP, direct the person to the Preferred Priorities for Care (PPC) document and/or complete the pertinent document (Advance Statement of Wishes & Preferences (ceilings of treatment), Advance Decision to Refuse Treatment) or parts of the document. 4. If further conversations are needed at another time, hand this on to another healthcare professional e.g. GP, District Nurse, or arrange another appointment 5. Gain consent to share the information with other relevant healthcare professionals 6. Complete the Notification of Advance Care Planning form, retain a copy of this in the health records and forward the most recent copy to relevant healthcare professionals. If a healthcare professional makes any updates or amendments, they are responsible for sharing the updates with healthcare professionals as outlined on the Notification of Advance Care Planning form. Table 1: Possible outcomes of ACP discussion, and relevant documents to use Lasting Power of Attorney Planning for your future care a Guide, is for people and those important to them. It explains Advance Care Planning and outlines the different options available to them including identifying wishes and preference, refusing specific treatment, making a Lasting Power of Attorney and where to go for further information. It is available in clinical areas and from: We recommend you provide this to all people who might benefit from ACP. Preferred Priorities for Care is a person-held document designed to facilitate individual choice in relation to end of life care. It focuses on preferences about how they would like to be cared for in the future, as well as the things that are important to them. Anyone can complete the document, not all of it needs to be completed. It is not appropriate for recording decisions about medical interventions or refusals of treatment. This document, as well as an Easy Read version and supporting information leaflets (Guide to Preferred Priorities of Care) are available in clinical areas and from: An Advance Statement of Wishes & Preferences (ceilings of treatment) can be used as a springboard for the professional to begin discussions which relate specifically to preferences regarding medical interventions during their illness e.g. clinically assisted nutrition, ventilation, CPR and other scenarios requiring hospital admission. Relevant areas are to be discussed with the patient if and when appropriate, and not all sections will necessarily be completed. The document is a dynamic one, to reflect the patient s wishes as they progress along their illness trajectory. This should be shared, with the patient s permission, with other relevant healthcare professionals so that expressed wishes are taken into account at a time when the patient may not be able to engage in discussions themselves. A signature is not required, as it is not legally binding, but serves to make the multiprofessional team aware of the patient s wishes and preferences if a best interest decision needs to be made. An Advance Decision to Refuse Treatment (ADRT) (previously known as an advance directive or a living will) is a decision that can be made now to refuse a specific type of treatment, including potentially life saving treatment, at some time in the future. It lets family, carers and healthcare professionals know the person s treatment refusals if they are ever unable to make or communicate that decision themselves. The treatments the person is deciding to refuse (including potentially life saving treatments) must be specifically named in the ADRT and the decision must be signed by them. The individual must be competent to complete the ADRT at the time. NB The form used at BSUH (see below) will have the term written in full; Advance Decision to Refuse Treatment replacing Advance Decision cisions_to_refuse_guide.pdf Adults can choose and appoint an LPA to act on their behalf if in the future they lose capacity to make these decisions for themselves. The LPA can be for health and welfare and/or property and financial affairs. An LPA supercedes any ADRT. You should direct them to the Office of the Public Guardian at: Guidance written by the members of the BSUH End of Life Care Workstream 3 Communicating the patients journey across BSUH & the community Advance Care Planning process Task & Finish Group. September 2012 Guidance written by the members of the BSUH End of Life Care Workstream 3 Communicating the patients journey across BSUH & the community Advance Care Planning process Task & Finish Group. September 2012
15 The Martlets Hospice Notification of Advance Care Planning Current Address: NOK Address: Patient Label, or complete: Name: D.O.B: Trust ID no: NHS Number: Nominated NOK and relationship? Is there an existing Lasting Power of Attorney for Health and Personal Welfare? Yes/NO If Yes, please enter their name and contact details: Following a discussion about your future care, your Advance Care Plan includes the following documents: 1. Provision of the Planning for your future care A Guide booklet Yes/No 2. Preferred Priorities for Care Yes/No 3. Advance Statement of Wishes & Preferences Yes/No 4. An Advance Decision to Refuse Treatment Yes/No 5. Referral and advice on appointing a Lasting Power of Attorney Yes/No I consent to my Advance Statement and/or Advance Decision to Refuse Treatment and/or Lasting Power of Attorney being shared with the healthcare professionals indicated below. Signature: Name: Date: Named Healthcare Professional (HCP) Role/Team Hospital Health Records General Practitioner District Nurse Care Home Community Palliative Care Team Out of Hours GP Service Other (please state) This phase of my Advance Care Planning process was completed by: Name: Organisation/Role: Bleep no: Signature: Date: Time: Subsequent updates have been completed: Date: By whom: Organisation/role: Confirmation that they will inform HCPs above of the ammendments with my consent
16 Planning for your future care A GUIDE
17 Preferred Priorities for Care (Easy read) Preferred Priorities for Care
18 The Martlets Hospice The Martlets Hospice Advance Statement of Wishes and Preference Clinical Issue Date N/A Details/Decision Current Address: Nominated NOK and relationship? NOK Address: Patient Label, or complete: Name: D.O.B: Trust ID no: NHS Number: Other Scenarios Requiring Medical Intervention Including Hospital Admission Clinical Issue Date N/A Details/Decision Preferred Place of Care at the time of dying 1 st preference 2 nd preference Cardiopulmonary Resuscitation (CPR) Has a DNACPR form been completed by the GP/Consultant/other appropriately delegated clinician? Tissue and/or Organ Donation If appropriate, direct person to the NHS Organ Donor Register, or Transfusion of Blood Products Clinically assisted Nutrition and Hydration Are any of the following in place: -Advance Decision to Refuse Treatment (ADRT) -Lasting Power of Attorney - Health & Welfare &/or Property & Financial Affairs If yes, when last updated and where are copies This Advance Statement of Wishes and Preferences was completed by: Name: Organisation/Role: Bleep no: Signature: Date: Time: Assisted Ventilation Please ensure that with the patient s consent, this is shared with relevant health professionals (see Notification of Advance Care Planning form) and encourage the patient to also retain a copy. Subsequent Advance Statement of Wishes and Preferences updates have been completed: Date: By whom: Organisation/role: Confirmation that they will inform HCPs on notification sheet of the ammendments with patients consent Date Introduced: 06/08/12 Date of Approval: 27/07/12 File in: Health Records Clinical History 1 Date Introduced: 06/08/12 Date of Approval: 27/07/12 File in: Health Records Clinical History 2
19 STATEMENT OF PATIENT S WISHES Clinical Issue Advance Decision, Lasting Power of Attorney (LPA), Enduring Power of Attorney (EPA) Cardiopulmonary Resuscitation (CPR) Details/Decision If any in place, when last updated and where are copies held? None currently in place. If patient does not wish to be for CPR, has GP / Consultant signed DNAR form? Very clear about not wanting anything to prolong life. Only wants interventions that might improve quality of life and that allows her to stay at home. Discussion held about benefits and burdens of CPR. DNACPR form completed. Daughter aware. Staff sig: Date Staff sig: Date Artificial Feeding & Hydration Would be willing to have S/C fluids at home if felt to be clinically necessary and if would lead to relief of uncomfortable symptoms. Staff sig: Date Assisted Ventilation Not appropriate to discuss. Staff sig: Date Transfusion Of Blood Products Not explored today. Staff sig: Other Scenarios Requiring Hospital Admission Preferred Place of Care Currently on oral ABs for chest infection. Wants to avoid hospital admission so would only consider IVABs if this could be administered at home and if felt that this would provide symptomatic relief. Home. Date Staff sig: Date Staff sig: Date
20 STATEMENT OF PATIENT S WISHES Clinical Issue Advance Decision, Lasting Power of Attorney (LPA), Enduring Power of Attorney (EPA) Cardiopulmonary Resuscitation (CPR) Artificial Feeding & Hydration Assisted Ventilation Details/Decision If any in place, when last updated and where are copies held? None in place but pt keen to find out more and possibly draw up an ADRT. If patient does not wish to be for CPR, has GP / Consultant signed DNAR form? Very clear about not wanting to undergo CPR. Wants nothing to prolong life. Only wants interventions that might improve quality of life. Understands CPR would be futile. DNACPR form completed by Hospice Consultant. Wife present and aware of above. Had resp function assessment in Feb 2011 by community physio to assess whether RIG insertion would be safe /feasible. No further action taken. Pt and wife very keen to explore issue further but need more info. D/W community SALT and neurologist: not fit for RIG or PEG. Plan to review need for NGT feeding if/when resp function deteriorates less quickly than expected and/or swallowing deteriorates more rapidly. Dependent on NIPPV at night. Does not want invasive ventilation. Staff sig: Date Staff sig: Date Staff sig: Date Staff sig: Date Staff sig: Date Transfusion Of Blood Products Not explored today. Staff sig: Other Scenarios Requiring Hospital Admission Preferred Place of Care Currently on oral AB s for chest infection. Wants to avoid hospital admission if possible for IVAB s but would consider it if felt very unwell and if felt that this would provide symptomatic relief. Keen for decision to be made at the time in consultation with him if capacity or with wife if lacks capacity. Home. Date Staff sig: Date Staff sig: Date
21
22 Steps to proceed with ACP 1. Right person? Right 3me? 2. Provide the pa3ent with Planning your Future Care booklet 3. Begin discussions and explore which tools would be most helpful to document outcomes 4. Arrange further conversa3ons if needed with you or another professional and update documents accordingly 5. Gain consent to share informa3on
23 ACP For the paaent: Capacity Willingness to par3cipate Knowledge of op3ons available Communica3on Opportunity to review when needed/desired For the professional: An3cipate future care needs Effec3ve communica3on skills Confidence Team working Knowledge of key issues (legal, ethical) Clear documenta3on Provide opportuni3es for review/discussion
24 Which professionals should undertake ACP? Whoever iden3fies the need Whoever the pa3ent agrees to discuss the issues with Whoever responds to cues and takes the opportuni3es that arise All of us!
25 Clinical Outcomes in End of Life Care Death Quality of death Place of death
26 Actual place of death (MCT caseload) April 2007-March 2008 n=618 April 2009-March 2010 n=509 21% 10% 36% Hospice Home Hospital 23% 16% 29% Hospice Home Hospital 27% Care home 31% Care home
27 Actual Place of Death Home Hospice Hospital Care home Other MCT Caseload ( ) Home Hospice Hospital Care home Other England national average ( )
28 Concordance with recorded Preferred Place of Care April 2007-March 2008 April 2009-March % Achieved 15% Achieved 19% 69% Unknown Not Achieved 24% 61% Unknown Not Achieved
29 BSUH SPCT data % achieved expressed PPC % (having a cancer diagnosis made it 25% more likely) Actual PPC Home Hospice Hospital Care Home D/C from team Home 351 (77%) Expressed PPC Hospice 127 (69%) 52 6 Hospital 73 (96%) 3 Care Home 8 91 (81%) 14 Not expressed
30 Impact of ACP Reduc3on in inappropriate hospital admissions Reduc3on in unwanted clinical interven3ons Beder communica3on between pa3ent, carers and professionals Especially helpful out of hours and when pa3ent unable to express wishes PPC achieved for more pa3ents Reduced inappropriate costs
31
32 General Medical Council (2010) Treatment and care towards the end of life: good prac3ce in decision making. London: GMC. Available from: hdp:// Capacity, care planning and advance care planning in life limi3ng illness. A guide for Health and Social Care Staff. Available from: hdp:// Finding the words. A Na3onal End of Life Care Programme publica3on. Available from: hdp:// the- words Preferred Priori3es for Care. A tool for discussion and recording end of life wishes and preferences. Available from: hdp:// preferredpriori3esforcare Royal College of Physicians (2009) Concise Guidance to Good Prac3ce, number 12. Advance Care Planning. London: RCP. Available from: hdp:// of- life- care/pages/planning- ahead.aspx hdp:// hdp://
33 Contact details The Martlets Hospice The Macmillan Community Team BSUH Specialist PalliaAve Care Team
Advance Care Planning process: Guidance for Health Care Professionals.
Advance Care Planning process: Guidance for Health Care Professionals. This guidance has been developed by a range of professionals across the local health economy to assist you in documenting and sharing
More informationCommon words and phrases
Information Line: 0800 999 2434 Website: compassionindying.org.uk This is a guide to some words and phrases you may hear when planning ahead for your future care and treatment. If you have any questions
More informationBradford & Airedale. Palliative Care. Managed Clinical Network. Photo. Name: Advance care plan. Personal preferences and wishes for future care
Bradford & Airedale Palliative Care Managed Clinical Network Photo Name: Advance care plan Personal preferences and wishes for future care. V1 February 2015 Review Date: February 2018 What matters - the
More informationPatient information leaflet. Royal Surrey County Hospital. NHS Foundation Trust. Advance Care Plan. Supportive & Palliative Care Team
Patient information leaflet Royal Surrey County Hospital NHS Foundation Trust Advance Care Plan Supportive & Palliative Care Team Advance Care Plan A non-legally binding document to record your preferences
More information9: Advance care planning and advance decisions
9: Advance care planning and advance decisions This section explains how advance care planning and Advance Decisions to Refuse Treatment (ADRT) can support your future care. The following information is
More informationDo Not Attempt Cardiopulmonary Resuscitation (DNACPR) Policy
Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) Policy 1 Policy Title: Executive Summary: Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) Policy Cardiopulmonary resuscitation (CPR) can be attempted
More informationStatement of Choices ADVANCE CARE PLANNING.
Statement of Choices ADVANCE CARE PLANNING This Statement of Choices will help you record your wishes, values and beliefs to guide those close to you to make health care decisions on your behalf if you
More informationDNACPR. Maire O Riordan 14 th January 2015
DNACPR Maire O Riordan 14 th January 2015 Objectives NHS Scotland DNACPR policy Decision making framework and the forms DNACPR within ACP context Communicationwith patients, relatives and colleagues Background
More informationNorth Dakota: Advance Directive
North Dakota: Advance Directive 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
More informationPlanning for Your Future Care
Planning for Your Future Care Advance Care Planning Preparing for the future Assisting with practical arrangements Enabling the right care to be given at the right time Reproduced with kind permission
More informationYour 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 informationYour life and your choices: plan ahead
Your life and your choices: plan ahead About this booklet About this booklet This booklet is about some of the ways you can plan ahead and make choices about your future care if you live in Northern Ireland.
More information2
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 informationINDIANA Advance Directive Planning for Important Health Care Decisions
INDIANA 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 of
More informationMND Factsheet 44 Advance Directives
MND Factsheet 44 Advance Directives Last Updated 27/10/11 Introduction Living wills, advance decisions, advance directives and advanced medical directives are all names which are, or have been, applied
More informationADVANCE 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 informationNEW JERSEY Advance Directive Planning for Important Health Care Decisions
NEW JERSEY Advance Directive Planning for Important Health Care Decisions CaringInfo 1731 King St., Suite 100, Alexandria, VA 22314 www.caringinfo.org 800/658-8898 CARINGINFO CaringInfo, a program of the
More informationADVANCE DIRECTIVE PACKET Question and Answer Section
ADVANCE DIRECTIVE PACKET Question and Answer Section Please review the following facts regarding what an Advance Directive is, as well as your right as an adult to create one. If you decide to complete
More informationADVANCE MEDICAL DIRECTIVES
ADVANCE MEDICAL DIRECTIVES Health Care Declaration (Living Will) and Medical Power of Attorney What is an Advance Directive? Many people are concerned about what would happen if, due to a mental or physical
More informationA 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 informationPlanning for your future care
Planning for your future care A GUIDE 81 2 Planning for your future care Planning for your future care A GUIDE There may be times in your life when you think about the consequences of becoming seriously
More informationSomerset Treatment Escalation Plan & Resuscitation Decision Policy
Somerset County County-wide Policy Title: SOMERSET TREATMENT ESCALATION PLAN (STEP) & RESUSCITATION DECISION POLICY Keywords Not for CPR, DNACPR, Ceiling of Care, Treatment Escalation Plan, Allow Natural
More informationAdvance Care Plan Working in partnership to deliver excellent health care
Advance Care Plan Working in partnership to deliver excellent health care This document is a partnership between: NHS North East Hampshire and Farnham Clinical Commissioning Group, NHS Surrey Heath Clinical
More informationL 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 informationPolicies, Procedures, Guidelines and Protocols
Policies, Procedures, Guidelines and Protocols Document Details Title Advanced Decision to Refuse Treatment Policy and Procedure (previously known as Living Wills) Trust Ref No 443-24903 Local Ref (optional)
More informationILLINOIS 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 informationDecisions about Cardiopulmonary Resuscitation (CPR)
Decisions about Cardiopulmonary Resuscitation (CPR) Information for patients and those close to them This leaflet is about Cardiopulmonary Resuscitation (CPR) and how decisions are made about it. This
More informationUK LIVING WILL REGISTRY
Introduction A Living Will sets out clearly and legally how you would like to be treated or not treated if you are unable to make, participate in or communicate decisions about your medical care in the
More informationAdvance Directive. What Are Advance Medical Directives? Deciding What You Want. Recording Your Wishes
Advance Directive What Are Advance Medical Directives? These documents could be a living will or a durable power of attorney for healthcare (also called a healthcare proxy). They allow you to give directions
More informationTitle 18-A: PROBATE CODE
Maine Revised Statutes Title 18-A: PROBATE CODE Article : 5-804. OPTIONAL FORM The following form may, but need not, be used to create an advance health-care directive. The other sections of this Part
More informationAdvance Medical Directives
Advance Medical Directives What Are Advance Medical Directives? These documents could be a living will or a durable power of attorney for health care (also called a health-care proxy). They allow you to
More informationpeace of mind. Advance care planning document and instructions are enclosed for:
ACP Honoring Choices Booklet_Self Cover 16 PAGES 2-COLOR 01.12.17.qxd_Layout 1 2017-01-12 11:09 Page 3 I choose peace of mind. Take time to plan ahead now so future health care challenges don t create
More informationMENTAL CAPACITY ACT (MCA) AND DEPRIVATION OF LIBERTY SAFEGUARDS (DoLS) POLICY
MENTAL CAPACITY ACT (MCA) AND DEPRIVATION OF LIBERTY SAFEGUARDS (DoLS) POLICY Last Review Date Approving Body Not Applicable Quality & Patient Safety Committee Date of Approval 3 November 2016 Date of
More informationWEST VIRGINIA Advance Directive Planning for Important Health Care Decisions
WEST 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, a program
More informationYOUR RIGHT TO MAKE YOUR OWN HEALTH CARE DECISIONS
Upon admission to Western Connecticut Health Network, you will be asked if you have any form of an Advance Directive such as a Living Will or a Health Care Representative. If you have such a document,
More informationTheValues 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 informationAll clinical areas of the Trust All clinical Trust staff All adults with limited prognosis Palliative care team Approved. Purpose of this document
Trust Policy and Procedure Document Ref. No: PP(15)310 End of Life Care For use in: For use by: For use for: Document owner: Status: All clinical areas of the Trust All clinical Trust staff All adults
More informationVIRGINIA 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 informationAdvance [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 informationGEORGIA 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 informationAdvance Care Plan for a Child or Young Person
Advance Care Plan for a Child or Young Person West Midlands Paediatric Palliative Care Network NHS Number: Advance Care Plan for a Child or Young Person This document is a tool for discussing and communicating
More informationAdvance Care Planning. An Introduction
Advance Care Planning An Introduction Aims of the session A general introduction to Advance Care Planning. Explore the context in which advance care planning may be appropriate. Discuss how participants
More informationIndividualised End of Life Care Plan for the Last Days or Hours of Life Patient name Hospital number Date of birth
Individualised End of Life Care Plan for the Last Days or Hours of Life Patient name Hospital number Date of birth NHS number Informed by Five Priorities for Care: Recognise, Communicate, Involve, Support,
More informationMASSACHUSETTS ADVANCE DIRECTIVES
MASSACHUSETTS ADVANCE DIRECTIVES Advance directives are legal documents that protect your right to refuse medical treatment you do not want, or to request treatment you do want, in the event you lose the
More informationHealthStream 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 informationAdvance decisions to refuse treatment
NHS Improving Quality Advance decisions to refuse treatment A guide for health and social care professionals 2 Contents 1. Executive summary Advance decisions A quick summary of the Mental Capacity Act
More informationABOUT THE ADVANCE DIRECTIVE FOR RECEIVING ORAL FOOD AND FLUIDS IN DEMENTIA. Introduction
ABOUT THE ADVANCE DIRECTIVE FOR RECEIVING ORAL FOOD AND FLUIDS IN DEMENTIA Introduction There are two purposes to completing an Advance Directive for Receiving Oral Food and Fluids In Dementia. The first
More informationDo Not Attempt Resuscitation Policy
Do Not Attempt Resuscitation Policy PROV 27 March 2009 1 Document Management Title of document Do Not Attempt Resuscitation Policy Type of document Policy PROV 27 Description To ensure that do not resuscitate
More informationNEW HAMPSHIRE Advance Directive Planning for Important Health Care Decisions
NEW HAMPSHIRE 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
More informationMy Voice - My Choice
My Voice - My Choice My Advance Directive Table of Contents Introduction... 2 Words You Need to Know... 3 Legal Document... 4 Helpful Information about your Advance Directive... 10 What makes your life
More informationAdvance Health Care Directive Form Instructions
Advance Health Care Directive Form Instructions You have the right to give instructions about your own health care. You also have the right to name someone else to make health care decisions for you. The
More informationNSW ADVANCE CARE DIRECTIVE
NSW ADVANCE CARE DIRECTIVE This form deals with your future health care. The time may come when you cannot speak for yourself. By completing this form, you can give directions about what medical treatment
More informationDeciding 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 informationVIRGINIA 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 informationMARYLAND 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 informationThe Newcastle upon Tyne Hospitals NHS Foundation Trust
The Newcastle upon Tyne Hospitals NHS Foundation Trust Advance Decision to Refuse Treatment Policy (Advanced Refusal of Treatment/ Previously known as Living Wills) Incorporating the Mental Capacity Act
More informationNEW YORK Advance Directive Planning for Important Healthcare Decisions
NEW YORK Advance Directive Planning for Important Healthcare Decisions CaringInfo 1731 King St., Suite 100, Alexandria, VA 22314 www.caringinfo.org 800/658-8898 CaringInfo, a program of the National Hospice
More informationGEORGIA 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 informationSerious Medical Treatment Decisions. BEST PRACTICE GUIDANCE FOR IMCAs END OF LIFE CARE
Serious Medical Treatment Decisions BEST PRACTICE GUIDANCE FOR IMCAs END OF LIFE CARE Contents Introduction... 3 End of Life Care (EoLC)...3 Background...3 Involvement of IMCAs in End of Life Care...4
More informationADVANCE DIRECTIVE NOTIFICATION:
ADVANCE DIRECTIVE NOTIFICATION: All patients have the right to participate in their own health care decisions and to make Advance Directives or to execute Power of Attorney that authorize others to make
More informationALASKA 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 informationHEALTH CARE DIRECTIVE
1 HEALTH CARE DIRECTIVE I,, understand this document allows me to do ONE OR BOTH of the following: PART I: Name another person (called the health care agent) to make health care decisions for me if I am
More informationAdvance care planning for people with cystic fibrosis. guideline for healthcare professionals
Advance care planning for people with cystic fibrosis guideline for healthcare professionals Advance care planning for people with cystic fibrosis guideline for healthcare professionals Contents Introduction
More informationHealth Care Directive
Health Care Directive Overview Adults with decision-making capacity have the right to make choices about their health care. No treatments may be given to someone who does not want them. The attached Durable
More informationAdvance Health Care Directive. LIFE CARE planning. my values, my choices, my care. kp.org/lifecareplan
Advance Health Care Directive LIFE CARE planning my values, my choices, my care kp.org/lifecareplan Name of provider: Introduction This Advance Health Care Directive allows you to share your values, your
More informationCOMBINED ADVANCE HEALTH CARE DIRECTIVE
COMBINED ADVANCE HEALTH CARE DIRECTIVE Before you sign: Read this form carefully. Choose which sections you wish to include, and fill in the blanks. If you want to add specific instructions in your own
More informationUNDERSTANDING ADVANCE DIRECTIVES
UNDERSTANDING ADVANCE DIRECTIVES If you have questions, call 377-3439 or pager 790-7284. Watch the Advance Directives film on Channel 4 at 9:00 a.m. and 5:30 p.m. NORTH MISSISSIPPI MEDICAL CENTER North
More informationWYOMING 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 informationWest Kent CCG Emergency Health Care Plan
West Kent CCG Emergency Health Care Plan 20 October 2015 Bruno Capone Local situation 11486 Elderly 85+ 3800 Care home residents in West Kent area Average life expectancy of nursing home residents is 6-9
More informationCompletion of Do Not Attempt Resuscitation (DNAR) Forms
Completion of Do Not Attempt Resuscitation (DNAR) Forms The Trust DNAR Policy includes the DNAR form. Please take time to read the Policy. It is essential that when a DNAR decision has been made, the DNAR
More informationGEORGIA 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 informationAdvance Decision to Refuse Treatment (ADRT) Policy
Advance Decision to Refuse Treatment (ADRT) Policy This procedural document supersedes: PAT/PA 27 v.1 - POLICY FOR THE MANAGEMENT OF ADVANCE DECISION TO REFUSE TREATMENT (ADRT) Did you print this document
More informationMARYLAND Advance Directive Planning for Important Healthcare Decisions
MARYLAND Advance Directive Planning for Important Healthcare 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 informationMY 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 informationMARYLAND Advance Directive Planning for Important Healthcare Decisions
MARYLAND 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 informationAdvance Health Care Directives. Form Instructions
Advance Health Care Directives Form Instructions You have the right to give instructions about your own health care. You also have the right to name someone else to make health care decisions for you.
More informationDirective To Physicians and Family Or Surrogates (Living Will)
Directive To Physicians and Family Or Surrogates (Living Will) INSTRUCTIONS FOR COMPLETING THIS DOCUMENT: This is an important legal document known as an Advance Directive. It is designed to help you communicate
More informationAdvance Directive Procedure
Advance Directive Procedure Aim and Scope of Procedure To provide instructions on the management of Advance directives regarding care and treatment at the Phyllis Tuckwell Hospice. Adhering to the Reference
More informationWISCONSIN Advance Directive Planning for Important Health Care Decisions
WISCONSIN 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 informationMaking Decisions About Your Health Care. (Information about Durable Power of Attorney for Health Care and Living Wills)
Making Decisions About Your Health Care (Information about Durable Power of Attorney for Health Care and Living Wills) Following guidelines set by federal regulations, we would like to inform you of your
More informationLOUISIANA 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 informationMaryland 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 informationGeorgia 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 informationState 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 informationDiscussion. When God Might Intervene
In times past, people died from minor illnesses because science had not yet developed medical cures. Today, an impressive range of medical therapies and life-support technologies offer not only help to
More informationADVANCE 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 informationMY 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 informationEnd of Life Terminology The definitions below applies within the province of Ontario, terms may be used or defined differently in other provinces.
End of Life Terminology The definitions below applies within the province of Ontario, terms may be used or defined differently in other provinces. Terms Definitions End of Life Care To assist persons who
More informationMy Wishes for Future Health Care
My Wishes for Future Health Care Information Package Revised on 26 July 2010 Imagine that, without warning, you have developed a life-threatening illness and are in an intensive care unit of a hospital.
More informationCALIFORNIA ADVANCE HEALTH CARE DIRECTIVE
CALIFORNIA ADVANCE HEALTH CARE DIRECTIVE Explanation You have the right to give instructions about your own health care. You also have the right to name someone else to make health care decisions for you.
More informationADVANCE HEALTH CARE DIRECTIVE Including Power of Attorney for Health Care (California Probate Code Sections effective JULY 1, 2000)
ADVANCE HEALTH CARE DIRECTIVE Including Power of Attorney for Health Care (California Probate Code Sections 4600-4805 effective JULY 1, 2000) Introduction. This form lets you exercise your right to give
More informationHealth Care Directives
Fact Sheet Health Care Directives What is a Health Care Directive? A Health Care Directive is a document that lets you leave instructions about your health care and name a Health Care Agent. A Health Care
More informationAdvance Care Planning in life limiting illness Information for patients, families and carers
Advance Care Planning in life limiting illness Information for patients, families and carers Easy Read Shining a light on the future A member of staff or a carer can support you to read this booklet. They
More informationPlanning Ahead: How to Make Future Health Care Decisions NOW. Washington
Washington Planning Ahead: How to Make Future Health Care Decisions NOW Your Questions Answered About Washington Living Wills and Powers of Attorney for Health Care Table of Contents P 1 What You Need
More informationPENNSYLVANIA 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 informationLIFE CARE planning. Advance Health Care Directive. my values, my choices, my care WASHINGTON. kp.org/lifecareplan
Advance Health Care Directive WASHINGTON LIFE CARE planning kp.org/lifecareplan All plans offered and underwritten by Kaiser Foundation Health Plan of the Northwest. 60418811_NW 500 NE Multnomah St., Suite
More informationLOUISIANA 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 informationPreparing to help others think and plan ahead (Advance Care Planning or ACP) Kerry Macnish RN and Catherine Hughes RN Education team
Preparing to help others think and plan ahead (Advance Care Planning or ACP) Kerry Macnish RN and Catherine Hughes RN Education team Tell us. 1. Who you are 2. Who you care for 3. What you need from this
More informationOKLAHOMA Advance Directive Planning for Important Health Care Decisions
OKLAHOMA 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 (NHPCO),
More informationSaint Agnes Medical Center. Guidelines for Signers
597 Saint Agnes Medical Center Page 1 Guidelines for Signers What is an Advance Health Care Directive? An "Advance Health Care Directive" is a document you can use to appoint another person, such as a
More information