Purpose
To establish standardized procedures for handling advanced directives in vascular surgery patients and ensure compliance with patient wishes, legal requirements, and ethical standards.
Scope
This policy applies to all vascular surgery patients, healthcare providers, and staff involved in vascular surgical care.
Policy Components
1. Documentation Requirements
- Verify existence of advanced directives during pre-surgical assessment
- Obtain copies of current advanced directives
- Scan documents into EMR within 24 hours of receipt
- Document advanced directive status in pre-operative checklist
2. Patient Communication
- Discuss advanced directives during initial surgical consultation
- Review specific implications for vascular procedures
- Document all discussions in patient record
- Provide written materials about advanced directives
3. Perioperative Management
- Confirm advanced directive status before induction
- Place visible indicator in chart/EMR
- Review specific directives relating to:
- Resuscitation orders
- Blood product administration
- Emergency interventions
- Mechanical circulation support
4. Staff Responsibilities
Surgeon
- Review advanced directives with patient
- Document understanding and agreement
- Address conflicts between directives and surgical plan
Pre-operative Nurse
- Verify documentation
- Update EMR status
- Communicate directives to surgical team
Anesthesia Team
- Review directives before procedure
- Document any modifications for perioperative period
Special Considerations
Emergency Situations
- Protocol for emergency override
- Documentation requirements
- Communication with healthcare proxy
Modification Procedures
- Process for temporary suspension
- Reinstatement protocol post-procedure
- Documentation requirements
Legal Compliance
- State-specific requirements
- HIPAA compliance measures
- Documentation retention policy
Review and Updates
- Annual policy review
- Staff training requirements
- Compliance monitoring