Advance Directives, POLST and DNR Orders | Episode 78

A patient can do everything right. She signs a living will, completes a POLST form with her doctor and chooses no CPR. Then a hospital stay, a missing transfer packet and a default order change her record to “full code.” When she’s found unresponsive, the nurse follows what the record says. In this second episode of the end-of-life series on Lexcura Clinical Insights, Michelle Carroll, Founder and Chief Clinical Strategist of Lexcura Summit, explains the documents people mix up all the time: advance directives, health care proxies, DNR orders and POLST forms. She covers what each one does and why only some of them are orders a nurse or paramedic can act on. She also walks through the federal rules requiring facilities to ask about advance directives, and the Supreme Court case that recognized the right to refuse treatment. Using a fictional case, Michelle shows where these decisions usually break down: at admissions, readmissions and transfers. She also explains why courts have struggled with claims over being resuscitated against your wishes, and what recent settlements and nursing board discipline tell us. And she covers the opposite mistake, when a DNR is treated as “don’t treat” rather than “don’t start CPR.” For attorneys, she lists the records that decide these cases and the questions to ask of each one. This episode is educational and isn’t legal or medical advice.