From: "Brown, Ruth" <[log in to unmask]>
Does anyone on the list accept advance directives from patients "in advance"
- ie scan them onto the system and flag them as a special case prior to
their arrival? we have been asked if we can do it, and I am concerned that
to accept the advance directive and undertake to scan it in suggests that we
will be able to guarantee we won't start resus and I am not sure that is
possible
what do others think?
--> What a fascinating idea for a quick breakfast thinking session.
I think I would rather begin with a different question - not whether we
could do it, but whether we wanted to...
Some quick points on this:
1. IF we had such a directive AND it was applied correctly and timeously
then it will likely be what the patient wants, which is nice to do...
2. IF we had such a directive AND it was applied correctly and timeously
then it will likely save time and resources to the ED
3. I expect that, although recent attempts by non-physicians to invent a
computer system for us have failed, eventually all UK EDs will have
computers and many patients will arrive with their data on their person. So
we'll have to be able to accept and process their data quickly and
effectively - an advanced directive will be one more such data - no major
difference...
4. If you decide to do it and don't do it well, you'll likely be very sorry,
but that is not to say that it is not possible - it is merely something
which needs to be done right.
5. One suggestion, to assist in the set-up "on the day" is to ensure such
patients know they MUST come by ambulance to the ED (which they will likely
have to anyway) and ensure the ambulance service has a way of reading this
data of the advanced directive and alerting the ED with as much warning as
possible to allow staff there to scan through the directive and decide what
they will do before the patient gets in. IF patient gets in - the ambulance
may well be instructed to avoid doing something necessary for the patient to
survive to hospital - even more resource saving!
As for whether YOU can do it - this will depend on your IT set-up, on who
wants to know, on what your legal department wants and on how patients will
be expected to inform you of this directive. Of these, I expect the only
problem, as you DO have the IT, is what your legal department thinks... This
flag should not be difficult to process if you have the protocols in place
and only place on it directives which you think you can follow and inform
patients of the ones you cannot.
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