Purpose
To establish standardized procedures for handling advanced directives in colorectal surgery patients and ensure compliance with legal and ethical requirements.
Policy Components
1. Documentation Requirements
- Verify existence of advanced directives during pre-surgical assessment
- Obtain current copies for patient medical record
- Document patient's wishes regarding:
- Resuscitation status
- Healthcare proxy designation
- Specific procedures/interventions
- Artificial nutrition/hydration preferences
2. Timing of Discussion
- Initial consultation
- Pre-operative evaluation
- 24-48 hours before scheduled procedure
3. Required Forms
- Living Will
- Durable Power of Attorney for Healthcare
- POLST/MOLST if applicable
- DNR status documentation
4. Staff Responsibilities
Surgeon
- Review advanced directives with patient
- Document discussion in medical record
- Address specific concerns regarding colorectal procedures
Pre-operative Nurse
- Verify documentation
- Flag special considerations
- Ensure forms are readily accessible
5. Perioperative Considerations
- Temporary suspension of DNR orders during surgery
- Documentation of agreed-upon modifications
- Post-operative reinstatement protocol
6. Emergency Situations
- Protocol for cases without advanced directives
- Emergency contact procedures
- Documentation requirements
Review and Updates
- Annual policy review
- Staff training requirements
- Compliance monitoring
Legal References
- State-specific requirements
- Federal regulations
- Institutional policies