End of life care Flashcards
What is advanced care planning
process for identifying and communicating an individuals values and preferences regarding future health care
Why is ACP good
allows pt to prepare for decisions regarding health care and clarify values and goals of care for when they are no longer able to make decisions
Why is ACP important
it builds trust
reduces uncertainty
helps avoid confusion and conflict
permits peace of mind
What are advanced directives
Living will
Medical or Health care power of attorney
Do not resuscitate
What is a living will (advance directive)
Written statement that expresses your wishes about medical Tx that would delay death from a terminal condition
- Persistent vegetative state, or coma
- Basically speaks for you if you can’t communicate
What is a Medical POA
Document that lets you choose another person (“agent”) to make your health care decisions if you no longer can
-Can include limits
What is a physician order for life sustaining treatment (POLST)
Medical orders to be honored by health care workers during a crisis (essentially a DNR) BUT-
not available in all states; there are program requirements’ must have a valid clinician (MD, PA, NP)
Who makes these decisions
The pt (he can invite family/friends) If pt cant, check chart for Advanced Directive document (living will, MPOA, DPOA)
What if the patient does not have an AD
clinicians can identify and select a surrogate medical decision maker
Priority of surrogates in AZ are
Spouse (unless legally separated)
Adult child (if many kids, get consent of majority)
Pt parent
Domestic partner
Sibling of pt
Close friend
Lastly, patients physician (must get approval from institutions ethics committee)
Who can NOT be a surrogate
the treating health care provider
employee of the treating provider (unless related to pt)
owner, operator, or administrator (of their employee) of pt/s current health care facility
What is the “conversation project”
started in 2010 to help people talk about their wishes for end of life care, or help a provider talk to a patient
*Does not need to be notarized
What is “five wishes” composed of
1 (legal doc): the person I want to make care decisions for me
2 (legal doc): the kind of medical treatment I want or dont want
3: how comfortable I want to be
4: How I want people to treat me
5: What I want my loved ones to know
Where do you keep your five wishes ACD
somewhere in your home, safe, but not in a safety deposit box that is very hard to reach
What are the two power of attorneys
general POA: act in charge of finances, NOT medical aspects
must be Medical POA to make those decisions
Can you act from a living will?
No, you must act form a DNR (ex POLST, or a “code status”)
So even if someone’s will says they dont want to be placed on a ventilator but they don’t have a DNR, you still put them on a ventilator
What does a POLST include
do you want to be kept on meds? Abx? nutrition? ventilator? etc.
How often do you review POLST
Yearly
Do you have to have a lawyer to complete the AZ life care planning forms
No, but you DO need a notary!
What does the “life care planning packet” contain
registration agreement durable medical POA durable mental health POA living will letter to my representative prehospital medical care directive (DNR)
Is an autopsy required?
Not unless a medical examiner, district attorney, or district court judge requires it
What should you do if you dont know someone’s code status
CODE THEM!
Start basic life support while someone is looking for a patient’s code status and ACD
What is a clinician’s role in ACP
We emphasize that ACP is a process, not a document!
Partner with your patient and review if the condition changes
Point to remember
Just because we CAN do things in medicine, doesnt mean we SHOULD
