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Doctors Say Advance Directives Need Clarity and Specificity

Many patients who visit an emergency room have advance directives in place. However, it has been revealed that a misunderstanding of such documents on the part of health care providers could result in inappropriate care.

According to Dr. Ferdinando Mirarchi, Medical Director at the Department of Emergency Medicine at University of Pittsburgh Hamot, in Erie, Pennsylvania, when patients give their consent to living wills and physician orders for life-sustaining treatment, they think that these documents only apply when there are no other alternatives available to prolong their life. However, they apply at every stage of care and treatment, particularly at the beginning.

As a result of this finding, TRIAD studies were performed that were based on the fact that the forms are not individualized for the patient, they do not contain informed consent by the patient or the dependent, and they are misunderstood as orders to “do not resuscitate” or “do not treat.” It was revealed that there is much confusion throughout the country regarding how to interpret the documents in cases where the patient is critically ill.

In order to clarify the patient’s wishes, Dr. Mirarchi advocates the use of a resuscitation checklist and an advance directive patient safety checklist. Steps should also be taken to individualize care and create a care plan at the bedside. In this way, medical errors will likely be avoided due to a misunderstanding of living will documents.

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