Advanced Directives Policy and Protocol for Cardiac Surgery Patients

1. Purpose

To establish standardized procedures for obtaining, documenting, and honoring advanced directives for cardiac surgery patients.

2. Scope

Applies to all healthcare providers involved in cardiac surgical care, including surgeons, anesthesiologists, nurses, and support staff.

3. Policy Components

3.1 Initial Documentation

• Verify existence of advanced directives during pre-surgical consultation
• Obtain copies for medical record
• Document location of original directives
• Scan into EMR within 24 hours of receipt

3.2 Required Elements

• Living will specifications
• Healthcare proxy designation
• DNR/DNI status
• Specific cardiac interventions preferences
• LVAD-specific directives (if applicable)

3.3 Perioperative Considerations

• Temporary suspension of DNR during surgery
• Explicit timeframe for suspension
• Post-operative reinstatement protocol

4. Implementation Protocol

4.1 Pre-Surgery

1. Review directives with patient/proxy
2. Document any modifications
3. Obtain signatures for temporary DNR suspension
4. Place advanced directive status indicator on chart

4.2 During Surgery

1. Communicate directive status at time-out
2. Document any deviations
3. Maintain communication with proxy

4.3 Post-Surgery

1. Reinstate original directives per protocol
2. Update documentation
3. Communicate status to all team members

5. Special Circumstances

• Emergency surgery protocol
• Absence of advanced directives
• Conflicting family wishes
• Incapacitated patient protocol

6. Documentation Requirements

• Standard forms location
• Required signatures
• Timeline for updates
• Storage protocols

7. Review and Updates

• Annual policy review
• Staff training requirements
• Compliance monitoring