1. Prerequisites |
a. Physician is near patient room or on the unit so that the physician is immediately available to patient. |
b. Patient is unable or lacks capacity to participate in medical decision making, and the family discussion is necessary for determining treatments. |
c. Patient has organ failure. |
2. Documentation |
a. Patient is unable or lacks capacity to make medical decisions. |
b. The necessity to have the discussion (i.e. patient deteriorating and need for discussion of treatment options with family). |
c. Medically necessary treatment decisions for which the discussion was needed (i.e. continuing vs withdrawing mechanical ventilation, initiation of vasoactive medications, institution of artificial nutrition and hydration, do-not-resuscitate order). |
d. Time spent in preparation for and during family meeting discussing treatment options and goals of care. Do not include time providing grief or bereavement support. |