Advance Directives, Outside-the-Hospital DNR Orders and Health Care Decision-Makers
Explains how the Agency meets state and federal advance directive law: the written information given at the start of care, with a summary of Missouri law on declarations (living wills), durable powers of attorney for health care and outside the hospital do-not-resuscitate (OHDNR) orders; documenting in a prominent place whether the patient has an advance directive; never conditioning care on having one; honoring directives, revocations and OHDNR orders; conscience objections; and staff and community education.
About this policy
- Policy number
- MO-HSP-PR-03
- Version
- 1.0
- Main rule
- 19 CSR 30-35.010(1)(E)4
- Library
- Missouri hospice · 59 policies
- Category
- Client rights
- Sections
- 19
In short
- At the first visit, give every adult patient the advance directive information form and ask if they have a living will, a health care power of attorney or an outside the hospital DNR order.
- Record clearly at the front of the record whether the patient has an advance directive, and copy any document the patient has.
- Never make a DNR order or an advance directive a condition of hospice care.
- Keep any outside the hospital DNR order as the first page of the home folder, and send it with the patient on any transfer.
- If a patient takes back an advance directive or now wants CPR, write down their words and tell the case manager and on-call nurse at once.
- If there is no DNR order and the patient stops breathing, call 911, start CPR if trained, then call the on-call nurse.
What's inside
19 sections. The full text comes with the One-time Policy Pack.
- Terms of Reference
- 1. Purpose
- 2. Scope
- 3. Definitions
- 4. Policy Statement (19 CSR 30-35.010(1)(E)4; 42 CFR §418.52(a)(2))
- 5. Information at the Start of Care
- 6. Missouri Law Staff Must Know
- 7. Honoring Advance Directives and Orders
- 8. Revocation and Review
- 9. Conscience Objections and Transfers
- 10. Patients in Facilities and Transfers
- 11. Staff and Community Education
- 12. Responsibilities
- 13. Records and Compliance Monitoring
- 14. Staff Training
- 15. References
- 16. Related Policies and Forms
- 17. Approval
- 18. Revision History
An inspector may ask
- Where in this record do you document whether the patient has executed an advance directive?
- What written information about Missouri advance directive law do you give patients, and when?
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