JFK MEDICAL CENTER
DEPARTMENT/OWNER:
Risk Management
POLICY DESCRIPTION:
Do Not Resuscitate
Page 1 of 10
REPLACES POLICY DATED: 5/09
EFFECTIVE DATE: 4/11
REFERENCE NUMBER:
COMMITTEE APPROVAL:
APPROVAL DATE:
ADMINISTRATIVE APPROVAL:
APPROVAL DATE:
SCOPE:
Organization Wide.
PURPOSE:
To provide guidelines to assure that decisions regarding withholding of resuscitative services or life-prolonging
treatments and procedures for patients are made in the framework of a medically responsible, ethical and sensitive
process that protects the right of the patients and adheres to the Florida Statutes.
JFK Medical Center proposes the use of the "POLST" order set to serve as a guide for discussions regarding the
use/nonuse of specific resuscitative measures.
POLICY:
1.
2.
In accordance with Florida Law, JFK Medical Center agrees, that every competent adult has the fundamental
right to self-determination regarding decisions pertaining to his/her own health, including the right to choose
to refuse medical treatment. The Hospital will respect and abide by a patient's wishes for end-of-life life
decisions to the extent permitted by Florida State Statute and the federal law regarding "Self Determination".
JFK Medical Center recognizes that the purpose of cardiopulmonary resuscitation (CPR) is the prevention of
sudden, unexpected death. In the event of cardiac or pulmonary arrest, it is standard practice in the hospital
to perform CPR unless there is s specific "Do-Not-Resuscitate" order to the contrary.
3.
It is also recognized that there are clinical situations in which life prolonging procedures (such as artificial
nutrition and hydration, intravenous antibiotics, dialysis, etc) may be of uncertain medical value or medically
futile. Also the hospital recognizes the right of the patient to participate in decisions
affecting his or her life
and to have his or her values and beliefs respected within the limits of the law. In any
situation, a DNR
Order (as prescribed in the POLST order set) requires the consent of the patient or
surrogate or proxy.
4.
Living Wills or oral declarations, other advance directives, and POLST order sets (including those completed
by a physician not on staff at JFK Hospital) will be honored according to Florida Law and will be included as
a part of the patient's medical record. This applies to both inpatients and outpatients.
5.
The Right to Decline Life-Prolonging Procedures Law is applicable to all "Do Not Resuscitate Orders". To
this end, all patients must have support of the physician and staff as well as have the proper documentation of
such on the hospital record.
6.
The attending physician will make every effort during the hospitalization to transform a patient's wishes
outlined in their living will into an actionable POLST order set if one has not already been completed. The
original POLST order set will placed on the front of the medical chart (or entered into meditech via the
new CPOE system) for all to follow. Upon discharge from the facility, the original will be sent along with
the patient while a copy of the POLST order set will remain in the medical record.
7.
A patient will be presumed to be capable of making health care decisions for him/herself unless he/she is
determined to be incapacitated. Every patient shall be presumed to consent to the administration of
cardiopulmonary resuscitation in the event of cardiac or respiratory arrest, unless there is consent to the
issuance of a Do-Not-Resuscitate order.
JFK MEDICAL CENTER
DEPARTMENT/OWNER:
Risk Management
POLICY DESCRIPTION:
Do Not Resuscitate
Page 2 of 10
REPLACES POLICY DATED: 5/09
EFFECTIVE DATE: 4/11
REFERENCE NUMBER:
COMMITTEE APPROVAL:
APPROVAL DATE:
ADMINISTRATIVE APPROVAL:
APPROVAL DATE:
8.
9.
No person shall be required to make an advance directive as a condition for receiving health care services.
JFK Medical Center may not require a patient to execute and advance directive or to execute a new advance
directive using facility's forms. The patient's advance directive will be a part of his/her medical record.
All staff members participating in the request of Advance Directives will be educated on patient rights during
orientation and reorientation. Risk Management may be contacted for any questions.
DEFINITIONS (765.101)
"Physician Orders for Life Sustaining Treatment (POLST)" is an order set that aims to honor a patient's end of life care wishes
as stated in their oral or written living will. It must be signed by the attending physician (or his/her surrogate who also holds an
MD/DO degree) AND the patient (or his/her decision maker) in order to be valid.
"Do Not Resuscitate Order" means a written medical order prepared by the attending physician that documents instruction by
an adult patient, the patient's designated Surrogate, or an appointed Proxy, that in the event the patient suffers cardiac or
respiratory arrest, cardio-pulmonary resuscitation is to be withheld.
"Life Prolonging Procedures" means any medical procedure, treatment or intervention, including artificially provided
sustenance and hydration, which sustains, restores, or supplants a spontaneous vital function. The term does not include the
administration of medication or performance of medical procedures, which such medication or procedure is deemed necessary
to provide comfort care or to alleviate pain.
"Informed Consent" means consent voluntarily given by a person after a sufficient explanation and disclosure of subject matter
involved to enable that person to have a general understanding of the treatment or procedure and the medically acceptable
alternatives, including the substantial risks and hazards inherent in the proposed treatment or procedures, and to make a
knowing health care decision without coercion or undue influence.
"Advance Directive" means a witnessed written document or an oral statement in which instructions are given by a principal or
in which the principal's desires are expressed concerning any aspect of the principal's health care, and includes, but is not
limited to, the designation of a health care surrogate, a living will or an anatomical gift made pursuant to Part X of Chapter
732.
"Living Will or Declaration" means:
1.
A witnessed document in writing, voluntarily executed by the principal in accordance with s. 765.302; or
2.
A witnessed oral statement made by the principal expressing the principal's instructions concerning lifeprolonging procedure Health Care Surrogate" means any competent adult expressly designated by a principal
to make health care decision on behalf of the principal upon the principal's incapacity.
"Durable Power of Attorney for Health Care” is an appointed agent, or a so called "attorney-in-fact", to act for individual in
execution of legal, business, property affairs and making of health care decisions in place of establishing a legal guardian.
"Informed Consent" means consent voluntarily given by a person after a sufficient explanation and disclosure of subject matter
involved to enable that person to have a general understanding of the treatment or procedure and the medically acceptable
alternatives, including the substantial risks and hazards inherent in the proposed treatment or procedures, and to make a
knowing health care decision without coercion or undue influence.
"Proxy" means a competent adult who has not been expressly designated to make health care decisions for a particular
incapacitated individual, but who,
nevertheless, is authorized pursuant to s. 765.401 to make health care decisions for such individual.
JFK MEDICAL CENTER
DEPARTMENT/OWNER:
Risk Management
POLICY DESCRIPTION:
Do Not Resuscitate
Page 3 of 10
REPLACES POLICY DATED: 5/09
EFFECTIVE DATE: 4/11
REFERENCE NUMBER:
COMMITTEE APPROVAL:
APPROVAL DATE:
ADMINISTRATIVE APPROVAL:
APPROVAL DATE:
"Close Personal Friend" means any person 18 years of age or older who has exhibited special care and concern for the patient,
and who presents an affidavit to the health care facility or to the attending or treating physician stating that he or she is a friend
of the patient; is willing and able to become involved in the patient's health care; and has maintained such regular contact with
the patient so as to be familiar with the patient's activities, health, and religious or moral beliefs.
"Incapacity or Incompetent" means the patient is physically or mentally unable to communicate a willful and knowing health
care decision. For the purpose of making an anatomical gift, the term also includes a patient who is deceased.
"End Stage Condition" means a condition that is caused by injury, disease, or illness which has resulted in severe and
permanent deterioration, indicated by incapacity and complete physical dependency, and for which, to a reasonable degree of
medical certainty, treatment of the irreversible condition would be medically ineffective.
"Terminal" means a condition caused by injury, disease, or illness from which there is no reasonable medical probability of
recovery and which without treatment can be expected to cause death.
"Persistent Vegetative State" means a permanent and irreversible condition of unconsciousness in which there is:
1.
The absence of voluntary action or cognitive behavior of any kind
2.
An inability to communicate or interact purposefully with the environment
PROCEDURES FOR DNR AND WITHHOLDING/WITHDRAWING LIFE SUPPORT
A.
PROCEDURE IN PRESENCE OF AN ADVANCE DIRECTIVE/LIVING WILL (Competent and Incompetent
Patient)
A "Living Will" is a written declaration that is used to direct the providing, withholding or withdrawing of lifeprolonging procedures in the event that the person has a terminal illness, or has an end-stage condition or is in a
persistent vegetative state.
In addition to making a living will, an individual may wish to name a Health Care Surrogate. If the patient wishes to
designate a surrogate for the first time or to designate a new surrogate, the patient should complete the "Designation of
a Health Care Surrogate" form.
This procedure is to be used if the patient has provided documented evidence of having made a living will and/or
designated a Health Care Surrogate or Power of Attorney for Health Care Decisions.
1.
The nurse shall obtain a copy of the Living Will Declaration and
place it in the medical record.
2.
If the patient is oriented and a surrogate has not been appointed request that the patient designate a health
care surrogate
3.
If the patient has made an Advance Directive/Living Will and is competent, the attending physician may
proceed as directed by the patient in the living will.
4.
If the patient is not competent (lacks decision making capacity) and has designated a Health Care Surrogate,
the attending physician may proceed as directed by the Health Care Surrogate and in accordance with the
Advance Directive. If a Health Care Surrogate has not been named, a proxy shall be determined according to
the guidelines provided in this policy.
5.
If the patient has made an Advance Directive/Living Will and lacks the ability to make an informed decision,
the designated surrogate or proxy can make the decision regarding withholding/withdrawing of life support
and making the patient a DNR according to patient's advance directive. If there is no designated surrogate or
proxy, the physician can follow the patient's wishes according to the living will.
JFK MEDICAL CENTER
DEPARTMENT/OWNER:
Risk Management
POLICY DESCRIPTION:
Do Not Resuscitate
Page 4 of 10
REPLACES POLICY DATED: 5/09
EFFECTIVE DATE: 4/11
REFERENCE NUMBER:
COMMITTEE APPROVAL:
APPROVAL DATE:
ADMINISTRATIVE APPROVAL:
APPROVAL DATE:
6.
7.
B.
Before proceeding in accordance with the patient's living will, if the patient lacks decision making capacity,
the designated surrogate, if there is one, or the appointed proxy, if there is no designated surrogate must be
satisfied of the following:
a.
The patient does not have a reasonable probability of recovering decision making capacity so that
the right to make decisions could be exercised directly by the patient, and
b.
The patient's physician and one other physician have determined that the patient has a terminal
condition, or has an end-stage condition, or is in a persistent vegetative state and
c.
Any limitations or conditions expressed orally or in a written declaration has been carefully
considered and satisfied.
The patient, health care surrogate and/or family members will have the opportunity to discuss the
considerations of these decisions with the physician before making the decision. Pastoral counseling
will be obtained if requested.
PROCEDURES IN THE ABSENCE OF ADVANCE DIRECTIVES (Appointment of a Proxy)
1.
The Hospital recognizes that the absence of a Declaration does not create a presumption of the patient's intent
to consent or to refuse life-prolonging treatment.
2.
If the patient has not executed an advance directive or designated a surrogate to execute an Advance
Directive, or the surrogate is no longer available to make health care decisions, a Proxy may be appointed to
make health care decisions for the patient. Any of the following individuals may be appointed as a Proxy in
the following order of priority, if no individual in the prior class is reasonably available, willing or competent
to act.
a.
A judicially appointed guardian with authority to make health
care decisions for the patient, if one
has been appointed
b.
The patient's spouse
c.
An adult child of the patient, or if the patient has more than one adult child, a majority of the adult
children who are reasonably available for consultation
d.
The father or mother of the patient
e.
The adult sibling of the patient or the majority of the adult siblings who are reasonable available for
consultation
f.
An adult relative of the patient, who has exhibited special care and concern and who has maintained
regular contact with the patient and who is familiar with patient's activities, health, and religious or
moral beliefs
g.
A close friend of the patient "Close personal friend' means any person 18 years of age or
older who has exhibited special care and concern for the patient, and who presents an affidavit to
the hospital or to the attending or treating physician stating that he/she is a friend of the patient; is
willing and able to become involved in the patient's health care; and has maintained such regular
contact with the patient so as to be familiar with the patient's activities, health and religious or moral
beliefs.
h.
A clinical social worker licensed pursuant of Florida chapter 491, or who is a graduate of a courtapproved guardianship program. Such a proxy must be selected by the hospital's Clinical Ethics
Committee and must not be employed by the hospital. The proxy will be notified that, upon request,
the hospital shall make available a second physician, not involved in the patient's care to assist the
proxy in evaluating treatment. Decisions to withhold or withdraw life-prolonging procedures will
be reviewed by the hospital bioethics committee. Documentation of efforts to locate proxies from
prior classes must be recorded in the patient's record.
JFK MEDICAL CENTER
DEPARTMENT/OWNER:
Risk Management
POLICY DESCRIPTION:
Do Not Resuscitate
Page 5 of 10
REPLACES POLICY DATED: 5/09
EFFECTIVE DATE: 4/11
REFERENCE NUMBER:
COMMITTEE APPROVAL:
APPROVAL DATE:
ADMINISTRATIVE APPROVAL:
APPROVAL DATE:
3.
C.
The Proxy may then act only when:
a.
The patient's terminal condition, end-stage condition or persistent vegetative state must be certified
in writing, by the attending physician and one other consulting physician who has examined the
patient.
b.
The patient has been certified as incapacitated by the physician.
c.
The proxy's decision must be supported by clear and convincing evidence that the decision would
have been the one the patient would have chosen had the patient been competent.
PROCEDURES FOR DETERMINING CAPACITY AND PATIENT CONDITION
1.
Determination of Capacity
The patient is presumed to be capable of making health-care decisions for him/herself unless he/she is
determined to be incapacitated. Incapacity may not be inferred from the person's
voluntary or involuntary
hospitalization for mental illness or from his or her mental retardation.
If the patient's capacity to make health care decisions for him/herself or provide informed consent is in
question, the following procedure will be followed:
-
-
2.
the attending physician shall evaluate the patient's capacity
If the attending physician concludes that the patient lacks capacity, that evaluation shall be
documented in the medical record.
If the attending physician has a question as to whether the patient lacks capacity, another physician
shall also be called to evaluate the patient
If the second physician agrees that the patient lacks the capacity to make health care decision or
provide informed consent, as described in the definition section, the second physician will document
this evaluation in the physician's progress notes.
If the patient has a designated health Care Surrogate, the physician or staff shall notify the surrogate,
in writing, that his/her authority has begun.
In the event that the attending physician determines that the patient has regained capacity, the
authority of the surrogate shall cease. The physician's determination must be documented in the
Physician's Progress Notes.
Implementing Advance Directives in a patient without capacity to consent Prior to implementing a patient's
desire to have life-prolonging procedures withheld or withdrawn, the patient's attending physician and at least
one other consulting physician must separately examine the patient and document that a medical condition or
limitation referred to in the advance directive (end-stage condition, terminal condition, and/or persistent
vegetative state) exists and that there is no reasonable medical probability of recovery from such condition.
The findings of such examination must be documented in the patient's medical record and signed by each
examining physician before life-prolonging procedures may be withheld or withdrawn.
* See Definitions at beginning of policy for statutory definitions.
D.
PROCEDURE FOR "DO NOT RESUSCITATE ORDERS"
1.
DNR Decision Making:
a.
A DNR order may be written at any time by a physician after confirming this order with the patient
who has decision making capacity. If the patient is competent to participate in
JFK MEDICAL CENTER
DEPARTMENT/OWNER:
Risk Management
POLICY DESCRIPTION:
Do Not Resuscitate
Page 6 of 10
REPLACES POLICY DATED: 5/09
EFFECTIVE DATE: 4/11
REFERENCE NUMBER:
COMMITTEE APPROVAL:
APPROVAL DATE:
ADMINISTRATIVE APPROVAL:
APPROVAL DATE:
the decision and
the patient’s
b.
c.
d.
e.
f.
requests or agrees to be made a DNR, the physician must document this process in
medical record.
The attending physician will make every effort during the hospitalization to transform a patient's
wishes outlined in their living will into an actionable POLST order set if one has not already been
completed. (See policy on "Physician Orders for Life Sustaining Treatment (POLST)"
If a patient does not have decision making capacity and has a living will a DNR Order may be
written when the patient is determined by two physicians to have a terminal condition, or an endstage condition, or is in a persistent vegetative state. The evaluation of the patients’ condition must
be documented in the medical record by the attending physician and one other physician who has
independently examined the patient.
If the patient lacks the capacity to participate in the decision, the physician must evaluate patient for
capacity and document his findings in the medical record. If the physician is not sure of the patient's
competency/capacity, he must consult with the one other physician to agree that the patient lacks
capacity to make the decision.
Once the patient is determined not to have capacity to make the decision, the physician must discuss
the situation with a designated surrogate or appointed proxy and document their agreement with the
decision to withhold resuscitative measure.
Documentation of the patient's capacity and condition should be recorded on the "Certification of
Patient Capacity and Condition" at the end of this procedure. it is also acceptable to document the
decision and determination of patient's capacity and condition in a dated and signed progress note on
the patient's medical record.
2.
DNR Order
a.
Orders written in accordance with this policy are to be respected and carried out by all Hospital
Personnel
b.
Any order other than a DNR Order (e.g. Partial resuscitation, Chemical Code) is not allowed.
Orders regarding specific resuscitative measures must be precisely stated in terms of specific
modalities of therapy to be included or excluded and under what circumstances. Such an order
should be fully reviewed with all involved health care workers.
c.
Once the DNR decision has been made, there must be a written order by the attending physician on
the Physicians Order Sheet in the patient's medical record.
d.
A Telephone order for DNR may be accepted, provided all other requirements have been met.
Telephone order for "Do Not Resuscitate" must be signed within 24 hours by the ordering
physician.
e.
A DNR order may be accepted from the physician's designee who is taking calls for the attending
physician.
f.
DNR orders will remain at all times with the working chart. If
the chart is thinned, this order will
not be put in the thinned portion.
g.
Communication of the DNR will be provided to all caregivers including other departments that may
receive the patient for tests and procedures. Designation of DNR Status will be placed on the
patient's medical record and Kardex.
3.
Care of DNR Patient
a.
All patients, including those for whom a DNR Order has been written shall continue to receive
appropriate medical care that has not been refused, as well as routine comfort care, support,
privacy, counseling and comfort.
b.
DNR orders do not preclude other medical and/or nursing care such as providing comfort measures,
providing pain relieving medications and care, maintaining adequate airway, providing medications
JFK MEDICAL CENTER
DEPARTMENT/OWNER:
Risk Management
POLICY DESCRIPTION:
Do Not Resuscitate
Page 7 of 10
REPLACES POLICY DATED: 5/09
EFFECTIVE DATE: 4/11
REFERENCE NUMBER:
COMMITTEE APPROVAL:
APPROVAL DATE:
ADMINISTRATIVE APPROVAL:
APPROVAL DATE:
as ordered and feedings. Withholding of any other medical orders must be specifically requested by
patient or surrogate or proxy and written by the physician.
4.
E.
Temporary Suspension or Revocation of DNR Order
a.
Instances may arise when it is appropriate to temporarily suspend the DNR order. The physician
should carefully explain the situation to the patient and/or designee in order to help them make a
decision regarding temporarily suspending the order. Examples that may be cause for temporary
suspension of a DNR order include:
b.
A temporary medical problem which is easily correctable
c.
Palliative surgery for a pathological fracture; or
d.
Surgery for an unrelated condition
e.
Since anesthesia itself or special procedures can induce significant cardiopulmonary compromise,
suspension of DNR orders may be desirable for certain Surgical Procedures. The anesthesiologist
and/or surgeon should discuss the specific anesthesia and surgical risk with the patient/patient's
surrogate or proxy pre-operatively to ascertain whether the procedure can reasonably be undertaken
despite maintenance of a DNR order, or whether a modification of the order is necessary.
f.
A DNR Order may be revoked at any time by the patient and/or designee by a signed dated writing
or an oral expression of intent to revoke to the attending physician in the presence of another
witness.
PROCEDURE FOR "REMOVING LIFE SUPPORT" - CALL DONOR REFERRAL HOTLINE AT 1-800-255-4483
1.
Removal of a patient from the ventilator is one of the most difficult forms of withdrawing life-support and
often requires more time for consideration than that of withholding CPR or other treatments that might
prolong the dying process. Once the decision process has been made that the patient's condition is such that
resuscitative measures should be withheld and documentation supports
that decision, other life-prolonging
procedures may be removed or withheld as deemed appropriate
by the physician in consultation with the
patient, patient's surrogate or designated proxy. Documentation
of these decisions should be included in the
progress notes of the patient's medical record and an order written to
implement these measures.
2.
The documentation of consent for the removal of life support may be found on the form "Physician
Certification of Patient's Condition."
SPECIAL CIRCUMSTANCES
A. PATIENT'S WITHOUT ADVANCE DIRECTIVES AND IN PERSISTENT VEGETATIVE STATE
1.
For persons in a persistent vegetative state, as determined by the attending physician, in accordance with
currently accepted medical standards, who have no advance directive and for whom there is no evidence
indicating what the person would have wanted under such conditions, and for whom, after a reasonably
diligent inquiry, no family or friends are available or willing to serve as a proxy to make health care
decisions for them, life-prolonging procedures may be withheld or withdrawn under the following
conditions:
a.
b.
The person has a judicially appointed a guardian representing his or her best interest with authority
to consent to medical treatment; and
The guardian and the person's attending physician, in consultation with the clinical ethics committee
of the facility where the patient is located, conclude that the condition is permanent and that there is
JFK MEDICAL CENTER
DEPARTMENT/OWNER:
Risk Management
POLICY DESCRIPTION:
Do Not Resuscitate
Page 8 of 10
REPLACES POLICY DATED: 5/09
EFFECTIVE DATE: 4/11
REFERENCE NUMBER:
COMMITTEE APPROVAL:
APPROVAL DATE:
ADMINISTRATIVE APPROVAL:
APPROVAL DATE:
no reasonable medical probability for recovery and that withholding or withdrawing life prolonging
procedures is in the best interest of the patient.
2.
B.
CONFLICT RESOLUTION
1.
Decisions concerning removing or withholding life support and/or resuscitative services (including CPR)
from an individual are made by the patient in consultation with the Physician, Designated Surrogate or
Appointed Proxy and Family Members. Nursing and Risk Management assistance may be requested when
needed.
2.
If conflicts in this decision-making process occur, the patient's wishes, if known, take precedent.
3.
If the patient is not competent to state their decision regarding health care, conflicts will be settled with the
designated surrogate or appointed proxy in the patient's absence.
If the conflict cannot be resolved, or if any involved member desires, a referral may be made to the Ethics
Committee in accordance with the Ethics Committee Policy.
The patient's family, the Hospital, the Attending Physician or any other interested person who may
reasonably be expected to be directly affected by the decision may seek expedited judicial intervention, if
that person believes:
a.
The Surrogate's or Proxy's decision is not in accord with the patient's knowledge, desires or the
provisions of the law.
b.
The advance directive is ambiguous, or the patient has changed his/her mind after execution of the
Advance Directive.
c.
The Surrogate or Proxy was improperly designated or appointed or the designation of the Surrogate
is no longer effective.
d.
the surrogate or proxy has failed to discharge duties, or incapacity or illness renders the surrogate or
proxy incapable of discharging duties.
e.
The surrogate or proxy has abused powers
f.
The patient has sufficient capacity to make his or her own health care decisions.
4.
5.
C.
The Clinical Ethics Committee shall review the case with the guardian, in consultation with the person's
attending physician, to determine whether the condition is permanent and there is no reasonable medical
probability for recovery. The individual committee members and the facility associated with the Clinical
Ethics Committee shall not be held liable in any civil action related to the performance of any duties required
in this subsection.
TRANSFER OF A PATIENT
1.
An attending physician who because of moral or ethical standards refuses to comply with the living will of a
patient or the treatment decision of a surrogate or proxy lawfully authorized to make such decisions, shall
make a reasonable effort to transfer the patient to another physician or health care facility.
2.
If the patient has not been transferred within seven days following the decision to withdraw or withhold lifeprolonging procedures, the attending physician or the Hospital shall carry out the wishes of the patient.
ROLES OF HEALTH CARE WORKERS IN CARE OF THE PATIENT AT THE END OF LIFE
All care providers will assist patient and/or designated decision makers with decisions and needs of the patient at the end of
life. Concern for the patient's comfort and dignity will be the primary concern through all aspects of end of life care.
JFK MEDICAL CENTER
DEPARTMENT/OWNER:
Risk Management
POLICY DESCRIPTION:
Do Not Resuscitate
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EFFECTIVE DATE: 4/11
REFERENCE NUMBER:
COMMITTEE APPROVAL:
APPROVAL DATE:
ADMINISTRATIVE APPROVAL:
APPROVAL DATE:
Considerations of the patient and/or family's psychological, social, emotional, spiritual and cultural preferences will be used in
any decisions for appropriate care.
A.
PHYSICIAN
The attending physician is responsible for consultation and discussion with the patient and family and/or family
regarding end-of-life decisions. The decision to withhold or withdraw life support including the decision to withhold
CPR is ultimately between the physician and the
patient and/or designated representatives. It is the responsibility of
the Attending Physician to determine the appropriateness of withholding or withdrawing life-prolonging procedures
including resuscitative measures.
The physician is responsible for completing required documentation in the medical record, using the appropriate
forms and written orders.
B.
NURSING
1.
2.
3.
4.
5.
Nursing is the patient advocate and responsible for coordinating efforts to comply with the patient's wishes
regarding end of life care. The nurse will assist the patient, family, surrogate, proxy and any other significant
other person in the implementation of decisions regarding end of life care decision.
Nursing will facilitate communication with the physician, Case Management/Social Workers, Pastoral
Services, Hospice and any other supporting agencies to assist patient, family and designated decision makers
in implementing the wishes of the patient.
Nursing will assess pain levels with the patient and/or designated decision makers and institute comfort
measures during the end of life hospitalization. The patient's right to pain management will be respected and
supported.
Nursing will discuss with patient and/or designated decision-makers any end-of-life decisions regarding
treatments, procedures, organ donation, and autopsy to determine patient and family wishes and methods to
ease the implementation of these decisions.
Communicate to the Physician any revocation or changes of attitude regarding health care decisions.
C.
OTHER CLINICAL AND SUPPORT PERSONNEL
1.
Case Management may be consulted as needed to assist with the following care:
a.
Offering pastoral services by contacting appropriate community religious affiliations
b.
Contacting appropriate resources for family when needed (i.e. Hospice, Home Health
Organizations)
c.
Discussing and/or assisting in making final arrangements with supportive counseling
2.
Case Management should maintain contact with Nursing Personnel to review patient, family, surrogate or
proxy needs.
D.
CLERGY
The patient and his/her family will be offered the opportunity to receive pastoral support. At the patient's or family
request, the Clergy will be notified in order to provide spiritual counseling. The extent of spiritual counseling
provided will be determined by the patient and/or family. The Clergy may visit the patient and families as needed as
there are open visiting hours.
E. RISK MANAGEMENT
JFK MEDICAL CENTER
DEPARTMENT/OWNER:
Risk Management
POLICY DESCRIPTION:
Do Not Resuscitate
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EFFECTIVE DATE: 4/11
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APPROVAL DATE:
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APPROVAL DATE:
Risk Management Department will provide consultation with the physician, hospital staff, and patient/patient
representatives regarding the “Advance Directive Statute, Hospital Policy and avenues for resolving conflicts
regarding end-of-life decisions.
F.
CLINICAL ETHICS COMMITTEE
Any conflicts that can be resolved by hospital personnel, physicians and family may be referred to the Clinical Ethics
Committee using the Ethics Policy and Consultation Procedure.
Developed:
Reviewed:
Revised:
Owner:
7/97
10/07, 5/09
3/00, 4/03, 5/05, 4/11
Director of Risk Management