Pediatric Advanced Directives and Medical Decision-Making Policy

Purpose

To establish guidelines for the management and implementation of advanced directives in pediatric care settings, ensuring compliance with state laws while respecting family wishes and maintaining the highest standard of patient care.

Scope

This policy applies to all healthcare providers, staff members, and administrators involved in pediatric patient care.

Definitions

Advanced Directive

• A legal document specifying medical care preferences
• May include DNR orders, limitation of interventions, or specific treatment preferences
• Must be signed by legal guardian(s) and witnessed according to state law

Decision-Making Authority

• Parents/Legal Guardians
• Court-appointed representatives
• State-designated surrogates

Policy Guidelines

1. Documentation Requirements

• Advanced directives must be:
  • Clearly documented in the medical record
  • Readily accessible to all care providers
  • Updated annually or as circumstances change
  • Verified for legal validity

2. Implementation Procedures

1. Upon admission:

   • Request copies of existing advanced directives
   • Document presence/absence in EMR
   • Scan documents into medical record

2. During care:

   • Review directives before any major interventions
   • Confirm current validity with family
   • Update as needed based on changing circumstances

3. Special Considerations

• Emergency situations
• Religious/cultural preferences
• State-specific regulations
• Capacity determinations

Review and Updates

This policy shall be reviewed annually and updated as needed to reflect current legal requirements and best practices.

References

• State Healthcare Decisions Act
• AAP Policy Statement on Pediatric Advanced Care
• Hospital Bylaws
• State Medical Board Guidelines