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Advanced Directives: DNR and POLST

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Advanced Directives: DNR and POLST

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This course will be discontinued effective October 1st, 2018. You will have until December 31st, 2018 to complete the course and print your certificate. The replacement course is located here.

This course is not approved by the California Department of Social Services (CDSS).

This course is designed to teach you about Do Not Resuscitate Orders and other advance directives such as the POLST. In this course we will address several different types of advance directives, including: medical power of attorney, living will, DNR, and POLST.

Course Information:
  • Online Training Course
  • Credit Hours: 1
  • Types of Advance Directives
  • Physician Orders for Life-Sustaining Treatment
Helpful Instructions
 Purchasing Courses for Yourself Purchasing Courses for Yourself:

This Training course is delivered 100% online through our Online Campus. In order to enroll you in a course we will need to collect your First Name, Last Name and Email Address.

When you place your order we will create an account for you, or add the courses to your existing account if you are a return customer. Access to the Online Campus is based on your email address. If you are a return customer, please purchase using the same email address used previously to avoid creating a duplicate account.

The course(s) you purchase will be available within 10 minutes of purchase and your login information will be sent to the email address you provide.
 Purchasing Courses for Others Purchasing Courses for Others:

This Training course is delivered 100% online through our Online Campus. If you are purchasing for others or your employees, please make sure to provide the First Name, Last Name, and Email Address of the person who you are purchasing for.

IMPORTANT: Access to the Online Campus is based on email addresses. If you are purchasing for multiple people, each person must have a unique email address to access the Online Campus. DO NOT USE THE SAME EMAIL ADDRESS FOR DIFFERENT INDIVIDUALS!

When you place your order we will create accounts for each individual you are purchasing for. If you are a return customer, please purchase using the same email address used previously to avoid creating duplicate accounts.

Example: Jim is buying a course for Bob. Jim will provide Bob’s First, Last and Email before the course is added to cart. Jim then uses his personal information for the checkout process.

We understand no one likes to give out their information and that’s why we only require the course attendee’s First Name, Last Name and Email to add the course to your shopping cart.

The course(s) you purchase will be available within 10 minutes of purchase and each person’s login information will be sent to the email address you provide.


Course Objectives

    By the end of this course participants will be able to:
  • Define Advance Directives and common medical terms used when speaking about serious illness and end of life.
  • Describe the difference between Living Will and DNR orders.
  • Identify a POLST – Physician Orders for Life-Sustaining Treatment.
  • Understand how to honor the request of residents at the end of life.
  • Discuss the process and policy for emergency medical assistance, such as CPR, when a resident maintains an Advance Directive.

Course Outcomes

Hour One
  • I. Advance Care Directives: Types and Purpose
  • a. Advance care directives may include:
  • I. Medical Power of Attorney
  • ii. Living Will
  • iii. Request to Forego Resuscitative Measures/Do Not Resuscitate (DNR) Orders
  • iv. POLST (Physician Orders for Life-Sustaining Treatment)
  • II. Definitions
  • a. Common Medical Terms Used When Speaking About Serious Illness:
  • I. Advance Directives
  • ii. Antibiotics
  • iii. Artificial Nutrition
  • iv. Cardiopulmonary Resuscitation (CPR)
  • v. Comfort Measures
  • vi. Intravenous (IV) Fluids
  • vii. Mechanical Ventilation/Respiration
  • viii. Tube Feeding
  • ix. Medical Decision Maker
  • III. Questions and Answers Regarding DNR Orders
  • a. What Is Resuscitation?
  • I. Examples of what may be involved in CPR:
  • 1. Simple efforts such as mouth to mouth breathing and pressing on the chest
  • 2. Electric shock to restart the heart
  • 3. Reading tubes to open the airway
  • 4. Medications
  • b. How to Make the Decision Regarding DNR Orders
  • I. Things to Consider:
  • 1. Learn more about your medical condition and what to expect in the future.
  • 2. Talk to your physician about the pros and cons of CPR.
  • 3. There is always a right to change your mind.
  • c. How to Receive a DNR Order
  • i. The physician is required to follow the wishes of the patient, or:
  • 1. Must transfer the care to a physician who will carry out the wishes of the individual.
  • 2. Must agree to settle the dispute within 72 hours if the individual is a patient in a hospital or nursing home in order to follow his/her wishes.
  • ii. The Process of Obtaining a DNR Order Works As Follows:
  • 1. The doctor writes a DNR order on the person’s medical chart if he/she is in the hospital.
  • 2. The doctor can tell the person how to get a wallet card, bracelet, or other DNR documents to have at home or in a non-hospital setting.
  • 3. Standard forms may be available from your state’s Department of Health.
  • iii. If the person chooses to change his/her mind, it is necessary that he/she speaks with his/her physician immediately.
  • d. What If the Resident Is Not Capable of Making the Decision?
  • I. Things to consider:
  • 1. The family is not capable of overriding the DNR order already written by the physician at the request of the resident.
  • 2. The resident may have named someone to speak for him/her. For example: a health care agent. If so, this person or legal guardian may agree to a DNR order for the resident.
  • ii. This representative can agree to a DNR order for the resident only when:
  • 1. The resident is terminally ill
  • 2. Is permanently unable to decide
  • 3. CPR will not be successful
  • 4. CPR could cause more medical challenges for the resident rather than assistance
  • IV. The POLST (Physician’s Orders for Life-Sustaining Treatment)
  • a. The POLST is Designed to Ensure An Individual’s Wishes Are Followed By:
  • I. Turning treatment wishes of an individual into actionable medical orders;
  • ii. Ensuring portability from one care setting to another through the use of a standardized form.
  • b. Why The POLST Was Developed
  • I. Initially in response to seriously ill patients receiving medical treatment that were not consistent with his/her wishes
  • c. Who Should Have a POLST Form?
  • I. Appropriate for persons who are seriously ill with life-limiting, also known as terminal, conditions.
  • ii. Not intended to replace an advance directive, but to complement it.
  • d. Who Completes the POLST Form and Who Signs It?
  • I. Must be completed and signed by a licensed medical professional
  • 1. Physician
  • 2. Nurse Practitioner
  • 3. Physician Assistant
  • e. No POLST Program Requires POLST By Law. … It is always voluntary
  • I. Assists patients and health care professionals discuss and develop plans to reflect treatment wishes
  • ii. Assists physicians, nurses, health care facilities, and emergency personnel to know and honor a patient’s preferences for life-sustaining treatment.
  • f. If A State Doesn’t Have A POLST Program; Can A Form Still Be Used?
  • I. No – A POLST form would not be recognized by health care professionals in a state where there is not a POLST Program.
  • g. More Information Can Be Obtain At
  • V. Honoring the Resident’s Wishes…What To Do At The End of Life
  • a. Importance of Developing A Community Policy on Honoring The Advance Request to Forego Resuscitative Measures (DNR, Advance Directives, POLST, etc.)
  • b. Most Licensed Professionals Employed By the Community May Honor A DNR in Most States.
  • c. Non-Licensed Staff, Such As A Caregiver, May Have Training In CPR But Does Not Have Qualifications or Legal Authority To Make the Decision to Honor or Not Honor A DNR Order.
  • d. Sample Policies
  • I. Call 911
  • ii. Call Hospice
  • iii. Licensed Nurse on Duty

Instructor: Josh Allen, R.N.

Josh Allen is a Registered Nurse with over 20 years of experience in senior living. As the Director of InTouch at Home, Josh oversees all aspects of business development, care, services, and operations for the organization. As a part of the SRG Senior Living family of companies, InTouch at Home delivers personalized care and services to clients living in senior living communities as well as private residences across three states.

Josh also serves on the board of the American Assisted Living Nurses Association, and represents AALNA on the boards of the Center for Excellence in Assisted Living and Coalition of Geriatric Nursing Organizations. Josh has previously served as President and CEO of Care and Compliance Group, a leading training solutions provider.

Additional Information

Canonical Link No
Course Type Online Course

Advanced Directives: DNR and POLST