Advanced Directives Policy for Endocrinology Practice

Purpose

To establish standardized procedures for obtaining, documenting, and honoring patient advanced directives in endocrinology practice settings.

Policy Statement

This practice recognizes and respects patients' rights to make informed decisions about their medical care, including end-of-life decisions and treatment preferences.

Procedures

1. Initial Patient Contact

• Ask all new patients aged 18 and older about existing advanced directives
• Document presence or absence of advanced directives in EMR
• Request copies of existing documents for patient file

2. Required Documentation

• Living Will
• Durable Power of Attorney for Healthcare
• Do Not Resuscitate (DNR) orders, if applicable
• Specific directives regarding:
  • Insulin management
  • Emergency glucose management
  • Thyroid medication administration
  • Adrenal crisis management

3. Staff Responsibilities

Front Office Staff

• Inquire about advanced directives during registration
• Scan documents into EMR
• Flag charts appropriately

Clinical Staff

• Review directives during initial assessment
• Document specific endocrine-related preferences
• Update information annually or as needed

Providers

• Discuss advanced care planning with patients
• Document discussions in medical record
• Ensure compliance with stated preferences

Review and Updates

• Annual review of policy
• Update patient directives yearly
• Maintain compliance with state regulations

Emergency Protocols

Specific considerations for endocrine emergencies:

1. Diabetic ketoacidosis management preferences
2. Severe hypoglycemia intervention protocols
3. Adrenal crisis emergency measures
4. Thyroid storm management guidelines

Documentation Requirements

All advanced directives must be:

• Clearly marked in EMR
• Readily accessible to all providers
• Updated within past 12 months
• Compliant with state regulations