Clearing up confusion on advance directives –

A good piece on some of the limitations of advance directives and Do Not Resuscitate (DNRs) instructions i real-life scenarios, and some of the confusion that results. There is also the development of Physician Orders for Life-Sustaining Treatment (POLST), which travels with the patient’s medical records (and is brightly coloured, in this still paper-based age, to stand out). The following checklist is to reduce some of the interpretation issues. Quote:

When physicians encounter a situation where a patient has an advance directive, going through a short checklist may help to ensure that a patient’s wishes are followed correctly. The list, developed by Ferdinando Mirarchi, DO, and called the “resuscitation pause,” starts with the first five letters of the alphabet for easier recollection.

A: Ask patients or surrogates about the intention of their living will or DNR order.

B: Be clear about whether the patient’s condition is terminal, despite sound medical treatment, or whether the patient is experiencing a critical condition that is treatable.

C: Communicate clearly with patients and staff members if you feel the patient’s condition is reversible and/or treatable.

D: Discuss next steps with patients or surrogates and talk about an action plan. For example, if a patient is critically ill, medical staff and family members may agree to institute care for 72 hours. If no benefit is found, life-sustaining care can be withdrawn.

E: Explain to family members and staff that it’s OK to withhold or withdraw certain care as long as it correlates with the patient’s preconceived wishes.

Clearing up confusion on advance directives –


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