MOLST, Health Care Proxy and Electronic Code Status Order

1. MOLST, Health Care Proxy and Electronic Code Status Order

2. Goals of Education/ Implementation • Instruct clinicians in use of standard tools to communicate patient preferences across settings of care: • Health Care Proxy • MOLST (Medical Orders for Life Sustaining Treatment) • Electronic Code Status Order • Code Status Displays in Header • Order detail visible in the Legal Indicators Tab • NEW Clinical Panel Code Status/Advance Directive • Order detail pulls into P.DOC discharge referral

3. Health Care Proxy A basic ethical and legal right of every patient is to be able to make decisions about their medical care. If a person is unable to communicate, it is important that someone who knows their values and preferences can make decisions for them. If “invoked”, the Health Care Agent is expected to follow the patient’s wishes and make decisions as the patient would make them. All adults, even healthy adults, are encouraged to choose a Health Care Agent. Health care problems may arise suddenly; having a surrogate decision maker provides an extra layer of security.

4. Invoking the Health Care Proxy (HCP) • When the Health Care Proxy form is invoked by the provider, the agent becomes the legal decision maker. • Provider must be sure he/ she is communicating with the legal decision maker before making code status decisions with that person.

5. What is MOLST? Medical Orders for Life-Sustaining Treatment

6. MOLST is… A medical document that may be used in the context of advance care planning Suitable for patients of any age with an advanced illness Based on a patient’s current health status Valid medical orders for life-sustaining treatments A portable document that is valid across care settings MA MOLST Demonstration Project: http://www.molst-ma.org/

7. Which patients are suitable forMOLST? Patients of any age with an advanced illness including, but not limited to: • Life-threatening diseases • Chronic progressive diseases • Life-threatening injuries • Medical frailty • Any patient suitable for considering DNR orders MA MOLST Demonstration Project: http://www.molst-ma.org/

8. MOLST form side 1: Medical Orders

9. MOLST form side 2: Patient Preferences

10. Key Workflow Decisions: Emergency Dept & Hospital Paper process in ED.  Electronic process in inpatient setting.   Code status orders will be standardized in Meditech 6.0 and a code status order will be required for every inpatient upon admission Meditech 6.0 code status/ limitations in care supersede the MOLST form in the inpatient setting

11. Electronic Code Status ORDER IN MEDITECH

13. Use the type ahead search to find Code Status order

14. Check Mark the Order > Next in the Footer

15. Complete the Required Fields

16. Advanced Directive Discussion and List by Priority Order Special Circumstances = If patient is not competent and has no surrogate decision maker, refer to End of Life policy for DNR ordering process.

17. Enter your PIN and Save Selected

18. Code Status on the Current Orders Screen

19. Detail on Legal Indicators Tab and Code Status appears in the Header

20. NEW Code Status/Advance Directive Clinical Panel

21. Detail in Clinical Panel View

22. Order Detail pulls into Discharge Referral

24. Complete Required Fields

25. Detail on Legal Indicators Tab and Code Status appears in the Header

26. Detail on Advance Directive Clinical Panel

27. Order Detail pulled into Discharge Referral

29. Complete Required Fields

30. Detail on Legal Indicators Tab and Code Status appears in the Header

31. Detail on Advance Directive Clinical Panel

32. Order Detail pulled into Discharge Referral