practice partner
medical staff sign a copy of each medical directive, it is acceptable for these individuals to receive copies of each directive and sign one statement indicating that they have read and agreed with all the medical directives referred to therein.
For examples of prototype medical directives, physicians are encouraged to consult the Emergency Department Medical Directives Implementation Kit which has been developed jointly by the Ontario Hospital Association( OHA), the Ontario Medical Association, and the Ministry of Health and Long-Term Care and is available on the OHA website. The specific requirements for medical directives are set out below.
1 Appropriate documentation A medical directive must include sufficient detail to ensure that it can be implemented. The following information must be included in a medical directive:
a) The name and a description of the procedure, treatment or intervention being ordered; b) An itemized and detailed list of the specific clinical conditions that the patient must meet before the directive can be implemented; c) An itemized and detailed list of any situational circumstances that must exist before the directive can be implemented; d) A comprehensive list of contraindications to implementation of the directive; e) Identification of the individuals authorized to implement the directive; f) A description of the procedure itself that provides sufficient detail to ensure that the individual implementing the directive can do so safely and appropriately; g) The name and signature of the physician( s) authorizing and responsible for the directive and the date it becomes effective; and h) A list of the administrative approvals that were provided to the directive. The dates and each Committee( if any) should be specifically listed.
This is where the templates will come in particularly handy as there is a strong emphasis on how to describe the indications and contraindications for the delegation. In addition, the patient’ s record must include documentation of the name and number of the directive, the name and signature of the delegate, and the name( s) of the authorizing physician( s).
2 Appropriate patient consent The protocol for the directive must include obtaining the appropriate patient consent. If the individual who will be enacting the medical directive is unable to provide the information required in order to obtain consent, the implementation of the medical directive is inappropriate.
3 Proper supervision Physicians must ensure there is a communication path that will enable the individual implementing a directive to identify the physician responsible for the care of the patient in order to contact him or her immediately, if necessary.
4 Ongoing monitoring and evaluation This would include ensuring the currency of the delegate’ s knowledge and skills. It would also include periodic evaluation of the delegation process itself to ensure it is safe and effective. Physicians should also consider tracking or monitoring methods to identify when medical directives are being implemented inappropriately or are resulting in unanticipated outcomes. MD
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Dialogue Issue 2, 2016