MOLST, Health Care Proxy and Electronic Code Status Order.
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Transcript of MOLST, Health Care Proxy and Electronic Code Status Order.
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
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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.
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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.
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/
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/
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
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.