Advance Directives

Advance Directives

May include any or all of the following:

• Living Will (or Directive to Physicians)
• Durable Power of Attorney for Healthcare designating surrogate decision maker(s) or proxy
• POLST (Physician Order for Life Sustaining Treatment) form

Registration personnel will verify if the patient has an advanced directive at the time of admission to Inpatient, Observation, Ambulatory Surgery (OPS), Emergency Department. WhidbeyHealth Home Health and Hospice Care clinical staff will ask adult patients whether or not they have an Advance Directive. Documentation will be recorded in the medical record stating whether or not the patient has executed an Advance Directive and, whenever possible, copies of applicable Advance Directives will be obtained, reviewed, and placed in the medical record. Individuals who have never been a patient at WhidbeyHealth may send a copy of their Advance Directives and the medical center will initiate a medical record to ensure documents are available for future admissions.

Patients will be provided care at WhidbeyHealth Medical Center regardless of the presence or absence of an Advance Directive. A patient may revoke or change an Advance Directive at any time, either verbally or in writing.

Documentation is to be included in the medical record regarding any revocation or change. If multiple forms of an Advance Directive are present in the medical record, the current copy will be considered the one with the most recent date.

At the time of admission to Inpatient, Observation, Ambulatory Surgery (OPS), Home Health, or Hospice Care, adult patients will receive written information, if not previously provided, on their right to make decisions concerning medical care they are to receive. This information will include their right to accept or refuse medical or surgical treatment and their right to formulate Advance Directives regarding the implementation of their decisions.

The Community Clinics and Outpatient services are not required to determine the status of Advance Directives on admission but are encouraged to do so as part of the patient assessment/intake process. Advance Directives are ideally formulated in the outpatient setting which allows time for patient/family education and discussion with professional caregivers.

Professional staff will provide education to patients/families regarding Advance Directives and provide assistance in completing them as much as possible. If there is question as to the patient’s decision-making capacity at the time an Advance Directive is being completed, the attending physician will make the determination. WhidbeyHealth Medical Center staff and physicians may not be witnesses for Advance Directives or designated as a patient’s proxy.

Conflict Resolution

If conflicts arise, or concerns are raised that Advance Directives are not being addressed, communication is to take place between the clinical staff, attending physicians/providers, and patient/family.

If conflict resolution is not accomplished successfully, the following avenues are available:

• Clinical staff may activate the policy for “Ensuring Appropriate Patient Care” (in the Administrative Policy Manual) or seek consultation from Nursing Executive(s) and/or the Clinical Ethics Committee.
• Medical staff may seek consultation from Chief of Service, Chief of Staff, the Clinical Ethics Committee, another physician, or Nursing Executive(s) as needed.
• Patients/families may be referred to Department Manager or Nursing Executive(s).  If a conflict remains unresolved, arrangement may be made to have the patient’s care transferred to another physician or to another institution as necessary. If such action is requested by patient/family, assistance will be provided by hospital staff as needed.

Education on Advance Directives, including relevant policies and procedures, is provided to hospital staff at the time of hire and on an annual basis. Education will be provided to the community at periodic intervals at least annually.