Withdrawal Of Care June 22, 2017
Withdrawal Of Care June 22 2017e
The objective of this review is to examine how the Durham Veterans Affairs Health Care System manages cases involving withdrawal of care, emphasizing policies and procedures to ensure compliance with federal, state, and local laws and regulations. The review assesses these procedures and the extent to which organizational stakeholders adhere to them, including ongoing education and policy compliance.
The target audience includes the Executive Leadership Team, Medical and Surgical Leadership Team, Providers, Nursing stakeholders, and the Health Information Management Team.
The organization has been engaged in assisting patients and families with end-of-life issues such as withdrawal of care for several years. This approach has facilitated open and honest communication between healthcare providers and patients or their families, ensuring that patient wishes are honored while dignified care is maintained. However, as laws and regulations evolve, it is crucial for the organization to stay current to protect all stakeholders and the organization itself. Regular educational updates are essential to ensure staff awareness of legal and regulatory changes, allowing them to support patients and families effectively in making informed decisions.
Currently, the organization discusses advance directives, living wills, and Do Not Resuscitate (DNR) orders with all hospitalized patients to determine if they possess such documents. If they do not, social workers are consulted to review these issues with patients who express interest. The concern is whether the staff’s knowledge regarding these directives remains current and fully compliant with applicable laws and regulations. It is vital that staff are well-informed and that processes reflect legal requirements.
The organization bears the responsibility to remain updated on legal and regulatory changes to deliver quality care that respects patient preferences. This involves providing continuous education to all stakeholders about current laws and policies governing withdrawal of care. By doing so, the organization can ensure that patients and families receive comprehensive information, enabling them to make informed healthcare decisions that align with their values and wishes.
Paper For Above instruction
Withdrawal of care is a critical aspect of end-of-life healthcare management that requires meticulous adherence to legal, ethical, and organizational policies. The Durham Veterans Affairs Health Care System’s approach to handling withdrawal of care underscores the significance of establishing clear policies, ongoing staff education, and compliance monitoring to uphold the dignity and wishes of patients while minimizing legal risks.
Legal and Ethical Foundations of Withdrawal of Care
Legal and ethical considerations form the foundation of withdrawal of care decisions. Federal laws such as the Patient Self-Determination Act (PSDA) mandate healthcare providers to inform patients about their rights concerning advance directives. State laws may further specify the requirements for assessing, documenting, and honoring these directives. Ethical principles such as autonomy, beneficence, non-maleficence, and justice underpin the decision-making process, emphasizing respect for patient choices and the importance of informed consent (Tolle et al., 2012).
In this context, respecting a patient’s autonomy involves ensuring that their expressed wishes—through DNR orders or living wills—are accurately documented and integrated into clinical care plans. Moreover, ethical care requires healthcare providers to balance these wishes with clinical considerations, especially in complex cases where care goals may conflict with medical judgment (Miller & Sande, 2014).
Policies and Procedures for Withdrawal of Care
The organization must have comprehensive policies guiding withdrawal of care, including criteria for decision-making, documentation procedures, and communication protocols. These policies should align with legal standards and ethical principles, providing clear guidance for clinicians, social workers, and other stakeholders (American Medical Association, 2015).
Effective procedures include early discussions about end-of-life preferences upon hospital admission, routinely reviewing advance directives, and ensuring that all documentation is current and accessible to care teams. These steps foster transparency and allow for patient-centered decision-making in an ethically sensitive manner (Bacchetta et al., 2017).
Furthermore, policies should outline the roles of interdisciplinary teams, including physicians, nurses, social workers, and chaplains, to support families and patients emotionally and informatively during withdrawal processes. Standardized documentation templates and checklists can assist in maintaining compliance and completeness of records (Kaldjian et al., 2013).
Staff Education and Training
Continuous staff education is crucial to maintain compliance with evolving laws and best practices related to withdrawal of care. Regular training sessions, workshops, and assessments ensure that all team members are aware of current legal standards and organizational policies (Glauser & Gustafson, 2016).
Training should include communication skills for discussing prognosis and end-of-life options empathetically, understanding legal documentation, and recognizing cultural and individual values influencing care decisions. Simulation exercises can enhance staff preparedness for complex discussions and ethical dilemmas (McDonnell et al., 2018).
Additionally, education modules should be updated frequently to reflect changes in laws such as the Patient Self-Determination Act, state legislation, and institutional policies, ensuring staff can provide legally compliant and ethically sound care (Detering et al., 2015).
Monitoring, Compliance, and Quality Improvement
Ongoing monitoring and evaluation of withdrawal of care practices are essential to ensure compliance and identify areas for improvement. Regular audits of documentation, decision-making processes, and adherence to policies help detect gaps or deviations (Carrington et al., 2017).
Feedback mechanisms, such as staff surveys and family satisfaction assessments, can provide insights into the quality of end-of-life care experiences. Data from these evaluations should inform continuous quality improvement initiatives, reinforcing adherence to best practices and legal requirements (Lucetta et al., 2014).
The organization should assign dedicated personnel or committees to oversee compliance efforts and conduct periodic trainings, ensuring sustainable improvements and adherence to regulatory changes.
Conclusion
The Durham Veterans Affairs Health Care System’s management of withdrawal of care illustrates the critical need for up-to-date policies, ongoing staff education, and rigorous compliance efforts. Respecting patient autonomy and ensuring legal and ethical integrity require continuous vigilance, interdisciplinary collaboration, and proactive communication. By prioritizing these elements, the organization can uphold its duty to provide respectful, legally compliant, and ethically sound end-of-life care, honoring the wishes of patients and their families while safeguarding organizational integrity.
References
- American Medical Association. (2015). Principles of Medical Ethics. AMA Journal of Ethics, 17(6), 569-576.
- Bacchetta, M., Danese, S., & Fumagalli, R. (2017). Ethical principles and end-of-life decision-making: A review. Bioethics, 31(2), 139-147.
- Carrington, P., Williams, M., & Haber, D. (2017). Monitoring end-of-life care quality: Evidence-based approaches. Journal of Palliative Medicine, 20(4), 374-380.
- Detering, K. M., et al. (2015). The impact of advance care planning on end-of-life care in elderly patients: A randomized controlled trial. BMJ, 350, g7859.
- Glauser, W., & Gustafson, C. (2016). Enhancing healthcare provider education for end-of-life care. Journal of Continuing Education in Nursing, 47(7), 310-315.
- Kaldjian, L. C., et al. (2013). Ethical challenges at the end of life: A review of institutional policies. Journal of Medical Ethics, 39(3), 195-199.
- Lucetta, Z., et al. (2014). Family satisfaction with end-of-life care. Palliative Medicine, 28(5), 436-442.
- Miller, K. D., & Sande, S. (2014). Balancing ethical principles in end-of-life decision-making. Ethics & Medicine, 30(2), 61-65.
- Tolle, S. A., et al. (2012). Ethical and legal aspects of withdrawing care. Clinical Ethics, 7(4), 133-137.