Introduction

TOC | Intro | 1 | 2 | 3 | 4 | 5 | 6 | 7 | Resources

Welcome to the 2008-2009 End of Life Care Manual. This manual contains materials to assist health care facilities, particularly hospitals, to meet the legal requirements regarding advance directives, surrogate decision-making, and organ procurement. The 2008-2009 edition of the End of Life Care Manual updates and expands the information provided in the 2001 edition. This updated version includes a new section on mental health advance directives and an expanded section on the Physician Orders for Life-Sustaining Treatment (POLST) Program.

Section One addresses federal and state law on advance directives. The section includes information on the Patient Self-Determination Act, Medicare Conditions of Participation for hospitals and long-term care facilities, and the Joint Commission standards on advance directives, end-of-life care, and surrogate decision-making. Washington state regulations specific to nursing homes are also summarized in Section One.

Section Two focuses on Washington state’s mental health advance directive law. In addition to an overview of the legal obligations of hospitals, this section contains a list of additional resources, a model hospital policy, clinician’s checklist, patient brochure, and sample mental health advance directive.

Section Three contains the text of the law discussed in Sections One and Two.

Section Four of this manual includes guidelines for developing hospital policies and procedures, creating patient information materials, and educating the community about advance directives. This information is intended to assist hospitals in meeting the requirements of the law discussed in Section One. A sample brochure on advance directives is provided at the end of this section.

Section Five addresses the law on surrogate decision-making. It focuses on the steps hospitals must take to comply with state law, Medicare Conditions of Participation, and Joint Commission standards. The texts of relevant state statutes and regulations are included.

Section Six contains information on the Physician Orders for Life-Sustaining Treatment (POLST) program. In addition to an overview of POLST, the section includes a list of resources, a POLST form, an example of DSHS approved policy and procedure guidelines for nursing homes, sample procedures for POLST intake, sample guidelines for nurses, and a patient brochure.

Section Seven describes hospital obligations regarding organ procurement, in particular Washington State’s new law concerning organ donation. The organ procurement section also includes a list of resources and a resource guide produced by the U.S. Department of Health & Human Services.

The last section is a Resource Section. The resources listed provide guidance for providers and patients faced with end-of-life decisions. The organizations listed provide information on end-of-life care, both general and specific. The providers’ resource page includes information pertaining specifically to best practices for the provision of palliative care. General information on advance directives can also be obtained from many of these organizations.

This guide is intended to inform hospitals of their legal responsibilities in relation to end-of-life care. The information presented is current as of September 2008. Please consult an attorney with specific questions or concerns.

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