Clinical Orientation Professional Direct Care Staff Advance Healthcare Directives Most of us are uncomfortable discussing terminal illness, but since patients/clients can be kept alive indefinitely with artificial life sustaining procedures, the patient/client must be educated regarding their right to express, in writing, their treatment choice if they become seriously ill or unable to communicate. This is the law. It is required that the patient/client be informed about advance directives during the admission process. In the event the patient/client has a Do Not Resuscitate (DNR), the admitting nurse should make every attempt to obtain a copy for the Agency record. It is also helpful, if the patient/client has a medical power of attorney, for the Agency to have the name and phone number of that individual. A list of the DNR patients/clients should be readily available in the on-call book. There are four ways to express choices in Texas: • Living Will – Allows the person to direct the physician not to administer artificial life sustaining procedures if the condition is defined as one in which death is imminent without these procedures. • Medical Power of Attorney for Healthcare – Allows the person to appoint an agent to make specific treatment decisions if unable to make these decisions for them self. • Out of Hospital DNR – Texas has implemented a specific procedure and DNR form to be utilized when a terminally ill patient decides to withdraw or withhold life sustaining measures or resuscitation. • Mental Health Directive – This document allows you to make decisions in advance about mental health treatment and specifically three types of mental health treatment: psychoactive medication, convulsive therapy, and emergency mental health treatment. A patient may revoke these decisions at any time. The physician and appropriate caregivers should be informed of this decision. If at any time the patient either revokes a decision or decides to implement Advance Directives, the office should be notified. Informed Consent Process The Agency will communicate with an adult surrogate, who may speak for the patient/client, for any adult patient/client who is comatose, incapacitated, or otherwise mentally or physically incapable of communication. The policy lists the adult surrogate in order of priority, who may consent and the procedure the Agency will follow to document the consent. Online Bookmark Title of Policy Rights and Ethics (RI) Advance Directives Informed Consent Process TX
