required for patients admitted under observation under VHA Directive 1036, Standards for Observation in VA Medical Facilities. Triggering events for patients with active LST orders and/or LST progress notes. If there is evidence that the orders no longer represent the patient’s preferences; or Prior to a procedure involving general anesthesia, initiation of hemodialysis, cardiac catheterization, electrophysiology studies or any procedure that poses a high risk of serious arrhythmia or cardiopulmonary arrest. NOTE: A patient’s LST orders must not be automatically suspended (see paragraph 11.a.(3) for more information). Triggering events for all patients. See paragraph 7 for alternate requirements for patients admitted to the ICU: Prior to writing DNAR/DNR orders or other orders to limit LST, including SAPO; At any patient encounter when the patient (or surrogate) expresses a desire to make decisions limiting or not limiting LSTs in the patient’s current treatment plan; or At any patient encounter when the patient (or surrogate) presents with SAPO for LST, unless the patient already has LST orders in CPRS that are consistent with the SAPO. See paragraphs 8.b. and 8.e. for more information related to SAPO. If a GoCC is indicated but the patient or surrogate chooses to defer the conversation or chooses not to make decisions about LSTs, or the practitioner determines that delay is clinically indicated, the practitioner must document this in the progress note for the encounter. Documentation in the encounter note does not discharge the obligation to reinitiate the GoCC when the patient (or surrogate) is ready. Preparing for a Goals of Care Conversation. In preparation for a GoCC, the practitioner must: If the patient’s decision-making capacity is in question, perform (or obtain) and document a clinical assessment of decision-making capacity. If the patient lacks decision-making capacity, identify the surrogate decision maker. Pursuant to 38 CFR 17.32, the order of surrogate priority in VA is: Health Care Legal Guardian or Special Guardian. Next of kin. The next of kin is a relative, 18 years or older, in the following order of priority: spouse; child; parent; sibling; grandparent; grandchild.
required for patients admitted under observation under VHA Directive 1036, Standards for Observation in VA Medical Facilities. Triggering events for patients with active LST orders and/or LST progress notes. If there is evidence that the orders no longer represent the patient’s preferences; or Prior to a procedure involving general anesthesia, initiation of hemodialysis, cardiac catheterization, electrophysiology studies or any procedure that poses a high risk of serious arrhythmia or cardiopulmonary arrest. NOTE: A patient’s LST orders must not be automatically suspended (see paragraph 11.a.(3) for more information). Triggering events for all patients. See paragraph 7 for alternate requirements for patients admitted to the ICU: Prior to writing DNAR/DNR orders or other orders to limit LST, including SAPO; At any patient encounter when the patient (or surrogate) expresses a desire to make decisions limiting or not limiting LSTs in the patient’s current treatment plan; or At any patient encounter when the patient (or surrogate) presents with SAPO for LST, unless the patient already has LST orders in CPRS that are consistent with the SAPO. See paragraphs 8.b. and 8.e. for more information related to SAPO. If a GoCC is indicated but the patient or surrogate chooses to defer the conversation or chooses not to make decisions about LSTs, or the practitioner determines that delay is clinically indicated, the practitioner must document this in the progress note for the encounter. Documentation in the encounter note does not discharge the obligation to reinitiate the GoCC when the patient (or surrogate) is ready. Preparing for a Goals of Care Conversation. In preparation for a GoCC, the practitioner must: If the patient’s decision-making capacity is in question, perform (or obtain) and document a clinical assessment of decision-making capacity. If the patient lacks decision-making capacity, identify the surrogate decision maker. Pursuant to 38 CFR 17.32, the order of surrogate priority in VA is: Health Care Legal Guardian or Special Guardian. Next of kin. The next of kin is a relative, 18 years or older, in the following order of priority: spouse; child; parent; sibling; grandparent; grandchild.
ModelMCM.docx