Transcript communication_consent.3.30
Communications during Life Limiting Illness & POLST in SC
Walter Limehouse, MD, MA MUSC Ethics Comte
Objectives
Identify SC Coalition for Care of Serious Illness (SCC-CSI)
Outline MUSC clinical policy C-169
Describe POLST in SC: POST
Serious Illness Communications
SCMA & SCHA
–revisit “medical futility” concern (2010) SCMA annual meeting resolution, May 2010:
STANDARD COMMUNICATION, CONSENT AND DECISION-MAKING PROCESS FOR SERIOUSLY ILL INPATIENTS IN SOUTH CAROLINA
Serious Illness Communications
SCMA House of Delegates, May 2010
Determine decision-making capacity according South Carolina law; Determine decision makers or surrogates; Determine patients’ understanding, beliefs, values, and wishes; Facilitate effective communication; and Call palliative care and/or ethics consults to address concern
s
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SC Coalition for Care of Serious Illness
(SCC-CSI)
Charter groups represent diverse state wide interests
SC Medical Association
SC Nurses Association
SC Hospital Association
SC Healthcare Ethics Network
Carolinas Center for Hospice & End-of-Life Care
SC Society of Chaplains, LifePoint, AARP
SCC-CSI Vision Statement
SC delivers excellent communication and shared decision-making for persons with serious, chronic, or terminal illnesses
SCC-CSI Initiatives @ MUSC
Improving communications
clinical policy C-169
Communication Process for Inpatients with Life Limiting Illness
POLST
Physician Orders of Life Sustaining Treatment
POST in SC
Physician Orders on Scope of Treatment
MUSC Clinical Policy C-169
Communication Process for Inpatients with Life Limiting Illness
Life-limiting illness triggers for communications process
Terminal illness with projected death within 6 months
Chronic debilitating illness with readmissions and/or multiple ED visits
Major events, like stroke, resulting in direct ICU admission or transfer
Other illnesses, as so determined by the attending physician
Process Facilitator
Nurse case manager or social worker as shepherd
facilitates completion of process forms with medical team schedules meetings as needed to develop or revise goals of treatment may document meeting discussions and attendance.
Process follows SCMA resolution
Determine decision-making capacity
Determine decision-makers or surrogates
Determine patients’ understanding, beliefs, values, and wishes
Facilitate effective communication and shared decision-making for time interval
Call palliative care and/or ethics consults to address concerns
Forms
Serious Illness Planning Progress Note
https://www.musc.edu/cce/ORDFRMS/pdf/all_all_docu_seriousillnesspl anningprognote.pdf
Serious Illness Continuing Care Planning Progress Note
POLST
paradigm
Physician Orders on Life Sustaining Treatment
Physician orders
scope of resuscitative treatment during life threatening emergency
Advance planning with patients
patient death not unexpected within 1 year Personal physician revises form with patient upon change of patient condition or choices annually
POLST
paradigm
Physician Orders on Life Sustaining Treatment
Orders cross institutional boundaries home, assisted living, skilled nursing facility EMS pre-hospital Hospital emergency department & inpatient POLST in Action in Oregon (video)
http://www.youtube.com/watch?v=CtrrnAJfT2s&context=C3f17b7bADOEgsToPDskJZLOgVI-NCrNBJSeCyi--I
Oregon POLST Form & Process -1991 -Bright Pink -Legally binding for EMS -Valid across institutional boundaries
SC EMS DNR Form & Process -Physician order -Legally binding for EMS -Valid only pre-hospital
National POLST Paradigm Programs Endorsed Programs Developing Programs No Program (Contacts)
*As of February 2012
POLST: POST in SC
Physician Orders on Scope of Treatment
SCC-CSI
organizational home for POST
SC POST form
- near ready for adoption.
DHEC
-
ready to authorize POST pilots
Greenville & Charleston
MUSC Medical Executive Committee
endorses CHARLESTON PILOT OF POST
collaborative initiative with MUSC & Roper
POLST:
POST in SC
Physician Orders on Scope of Treatment
SCMA annual meeting, April 2012
resolution endorsing POST being introduced
Questions: clinical policy C-169 or POST
Please contact:
Walter Limehouse MD MA [email protected]