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Advance Care Documents and Health CareProxyWhat is an Advance Directive?An Advance Directive is a document inwhich you may express your wishes regardingfuture treatment if, through illness or injury,there came a time you were not able to makeor communicate your own decisions. Uponadmission, the hospital will ask if you havean Advance Directive. If you have completedone, you should provide the hospital with acopy of the document.There are different types of AdvanceDirectives. They include the Health CareProxy, MOLST and the Living Will, which aredescribed below. If you would like additionalinformation, you should speak with anymember of your health care team.What is a Health Care Proxy and how does ithelp me?A Health Care Proxy is the legallyrecognized Advance Directive inMassachusetts. The Health Care Proxyis a simple form that allows you to namesomeone (called your Health Care Agent) tomake decisions for you if for any reason youbecome unable to make or communicate thesedecisions yourself. The purpose of the Proxy isto ensure your wishes are respected if you areunable to decide for yourself.What is a Living Will?A Living Will is a type of AdvanceDirective in which you express your choicesregarding future treatment. A Living Willis not legally recognized in Massachusetts.Although providing evidence of your wishes,a Living Will may not necessarily give yourHealth Care Agent sufficient authority tocarry out your wishes in the same way asa Health Care Proxy. The hospital’s HealthCare Proxy form includes a section where you6may provide instructions for your agent orspecifically limit his or her authority.What is a MOLST?MOLST is a medical order form (similar toa prescription) that relays instructions betweenhealth professionals about a patient’s care.MOLST is based on an individual’s right toaccept or refuse medical treatment, includingtreatments that might extend life. Patient’swith serious advanced illness at any agemay discuss filling out a MOLST with theirclinician.If I want a Health Care Proxy, what should Ido?Case managers can assist you with a HealthCare Proxy, you can reach them at (617) 8764344 ext. 3568. Discuss your decision withyour family, your doctor, and the person youwish to name as your Agent.Do I have to complete a Health Care Proxy?Although it is recommended, you are notrequired to complete a Health Care Proxy.If you become unable to make your owndecisions and you have not named a HealthCare Proxy, your family may be asked topursue guardianship though the court system.What are some decisions about my medicalcare that I should discuss with my physician orsomeone else on my health care team?You should discuss all aspects of yourmedical care with your doctor. When preparingan Advance Directive, it is particularlyimportant to talk about treatment such as: Resuscitation (sometimes called CPR):treatment to restore breathing and heartbeat. Itmay include pressing on your chest, providingmedications through intravenous lines, orplacing a tube down your throat connected to abreathing machine.

7 Ventilator: a breathing machine (orrespirator) to breathe for you if you cannotbreathe on your own. Food and Fluids: food and water providedthrough tubes if you are unable to eat on yourown. Medications: drugs used to control pain,restlessness, infections, or other conditions. Comfort: care that helps make youcomfortable but is not intended to treatyour condition. Bathing, positioning, andmoistening your lips if they are dry areexamples of comfort care.All additional policies of this facilityregarding your rights to make health caredecisions are available from the CaseManagement Department.Organ and Tissue DonationIt is the policy of Spaulding Hospital forContinuing Medical Care Cambridge, incompliance with Massachusetts General Lawand Federal Social Security Regulations, tooffer patients and their families the opportunityto consider organ and tissue donation. TheNew England Organ Bank (NEOB) facilitatesthe donation process. If you have questions,you may discuss donation with your physicianor speak with a representative of the NursingManagement Department. The department willcontact the NEOB with your inquiries.PATIENT SAFETYSpaulding Hospital for Continuing MedicalCare Cambridge is committed to providing asafe environment and to continuously striveto improve the delivery of patient care. Inorder to provide the best possible experiencefor you as a patient, we want you to know thefollowing information.What is the most important thing that you cando to ensure your safety?The single most important way you canhelp to ensure your safety, is to be an activemember of your health care team. Be involvedin taking part in every decision about yourhealth care.Changes in Your Medical ConditionThe hospital has established a system forearly recognition and timely response tochanges in a patient’s condition. Our RapidResponse Team is comprised of physicians,nurses, and respiratory therapists who provideadditional clinical assistance to the patient,family, and attending nurse when needed.Patients and family members are encouragedto alert caregivers if the patient’s conditionis of concern or appears to have changed. Atsuch time, if your concerns have not beenadequately addressed, please ask your nurse orcaregiver about a further evaluation involvingour Rapid Response System.Preventing Infection Handwashing is one of the best ways toprevent infection. Wash your hands well withsoap and warm water for at least 15 secondsafter using the bathroom, before touching oreating food, or after touching contaminateditems or surfaces. Use the alcohol-based handsanitizer to clean your hands when you leaveyour room to prevent spreading infections toothers. Remind health care providers and visitorsto wash their hands or use the alcohol-basedsanitizer before they treat/touch you. Practice respiratory etiquette by coughingor sneezing into the crook of your arm. If youhave to use a tissue, wash your hands after use.If there is any Precaution sign posted, speak tothe nurse to learn why.

8 Tell your physician/nurse about allprescription drugs, over the counter drugs,vitamins, herbs, or dietary supplements youtake. Tell your physician/nurse about anyThe Spaulding Hospital for Continuingallergies or adverse reactions you have had toMedical Care Cambridge Infection Controlmedications.Nurse may be contacted at extension 3000. Ask for information about your medicinesHow can you and your family become a part of in terms you can understand--both whenyour medicines are prescribed and when youthe healthcare team? Speak up if you have questions/concerns. receive them: Make sure you get the results of all tests/ The name of the drug and how much totake?procedures. What the drug is used for and what it is When you are leaving the hospital, askyour doctor/nurse to explain the care you will supposed to do? When will it work and how will you knowneed at home. Ask a family member or friend to be there it is working? When and how to take the drug--withwith you, and to be your advocate. Learn about your condition and treatments food, special instructions? How to store it?by asking your doctor and nurse and using What to report to the doctor?reliable resources. If it can be taken with over the counterdrugs, vitamins, herbs, or dietary supplements.Fall PreventionIf you would like more information onthings like MRSA or VRE, we have thatavailable. Please ask your nurse.As part of the nursing assessment uponadmission, a falls risk assessment is completedfor all patients. Also, within twenty-four hoursof admission, all patients are screened byoccupational and physical therapists to assesstheir mobility and safety. Personal safetydevices and alarms may be implementedwithin the assessment period. Appropriatemobility devices will be provided to patientsas needed.The Fall Prevention Program includeskeeping your: Call light within your reach Personal belongings within your reach Bed in lowest positionMedication SafetyMake sure that all of your doctors knowabout everything you are taking.When the nurse is administering medicationto you, ask what is being administered andwhy.Patient/Family Education on Use ofRestraintsWe want you to know that we are a facilitycommitted to restraint reduction. We believein providing the highest quality care, therebyimproving our patients’ quality of life. We feelwe can best accomplish this by minimizingrestraint use. In this way, we hope to preserveour patients’ dignity while providing themwith a safe environment. The Federal andState Government, along with the JointCommission, also encourages a move toward arestraint free environment.By definition, a physical restraint is “anymanual method or physical or mechanical

9device, material, or equipment, attachedor adjacent to the patient’s body that theindividual cannot remove easily whichrestricts freedom of movements or normalaccess to one’s body.” Examples of restraintsinclude: Vest/chest restraint Arm, wrist, waist, leg, or ankle restraint Wheelchair seatbelt, lapboard or bar that isnot self-releasing Full length bedrails or geri chairsMany adverse effects have been associatedwith the use of these restraints includingmuscle and bone weakening that can leadto immobility, chronic constipation andincontinence, low self esteem, withdrawal,depression, loss of dignity, pressure ulcers,and death due to suffocation or strangulation.Because of these possible serious effects, weare asking for your support in our restraintreduction policy.We will strive to meet your health needs,make our environment safe and provideyou and your family with the necessaryinformation to promote your own safety.We ask that you take responsibility to useappropriate caution, report safety concernsto facility staff, and take part in planning foryourself or for your family member’s safety.We believe we can provide a higher qualityof care and improve quality of life by reducingrestraint use and that this can be done withoutcompromising safety. If safety becomes anissue in our facility, our clinical team will meetwith you or your family to develop a plan toprovide the safest environment possible.If you have questions about our restraintreduction policy, feel free to contact anymember of the clinical team.for consultation with patients, families, andstaff who face difficult treatment and caredecisions.The Committee is available for discussionand advice on ethical issues that may resultwhen a question and/or conflict arises becauseof individual values and personal judgments.ON THE WAY HOMEDischarge PlanningThroughout your stay, your case managerwill work with you to arrange post-dischargeservices. We recognize that our patients arefacing complex illnesses and will need furtheraccess to healthcare services after their stayat SHC. Our staff of case managers willwork with you to set up individualized careat the appropriate setting for your continuedrecovery and rehabilitation.Skilled Nursing FacilityMany patients need continued inpatientnursing care and therapy before they are ableto return home. Your case manager will createa list of facilities for you based upon yourindividual care needs and your geographicalpreference. Ask your case manager forinformation about the Partners Skilled Nursing(SNF) Collaborative.Outpatient ServicesYour physician may prescribe outpatientrehabilitation. Your case manager will assistwith this transition. Spaulding offers theseservices in over 20 locations.Family Team MeetingSome patients and families find it helpful tohave a Family Team Meeting during their stay.You can ask your case manager to schedulea meeting for your family to meet with yourEthics Advisory Committeehealthcare team. These meetings generallyThe Ethics Advisory Committee is available last one hour and give you an opportunity to

10appropriate medical treatment and careavailable without regard to your economicstatus or the source of payment.6. For victims of sexual assault, to beHome Careprovided emergency treatment and medicallyYour physician may determine that theappropriate course of treatment includes home and factually accurate information aboutemergency contraception.care. Home care can be provided through7. To make decisions about the plan of carePartners HealthCare at Home, which servesprior to and during the course of treatment andmore than 70 cities and towns in Eastern andto refuse treatment to the extent permitted bySoutheastern Massachusetts.law and SHC policy, and to be informed ofthe medical consequences of this action. ThisPATIENT’S BILL OF RIGHTSincludes resuscitative and limitation of lifeWe, your health care team, promise tosustaining treatment.preserve your individual rights listed here8. To include or exclude any or all familyand ask for your cooperation. We also askmembers from participating in your healthyou and your visitors to understand yourcare decisions.responsibilities as a patient of Spaulding9. To consult with specialists (in addition toHospital for Continuing Medical CareCambridge and to be considerate of the rights any already involved in your plan of care) atyour own request and expense.of others.10. To expect a reasonable responseto requests for appropriate and medicallyAs a patient at Spaulding Hospital forContinuing Medical Care Cambridge you shall indicated care ad services, withing the capacityof SHC.have these Rights:11. To expect that your pain and symptomswill be assessed and treated with the goalCare and Treatment1. To be involved in all aspects of your care of minimizing your experience of pain anddiscomfort, to the extent clinically possible.and treatment.Patients are encouraged to tell their caregivers2.To equitable, considerate, respectfulabout their pain and discomfort experiencescare that includes consideration of yourand their responses to treatment, to bestpsychosocial, spiritual, cultural and personalfacilitate their pain and symptom management.values and beliefs.12. For dying patients, to care which3. To know the identity and specialty ofindividuals involved in your care. To refuse to optimizes dignity through the treatmentbe observed, examined, or treated by students of symptoms (as desired by the patient orHealth Care Proxy), the acknowledgement ofor any other staff without jeopardizing yourpsychological and spiritual concerns of theaccess to medical care.patient and family.4. For patients suffering for any type13. To expect reasonable continuity of care,of cancer, and specifically breast cancer,and to be informed by physicians and otherto receive information on all alternativecaregivers of available and realistic patienttreatments which are medically viable.care options when hospital care is no longer5. To receive prompt, life-saving treatmentappropriate.without delay and to receive the mostdiscuss your discharge plan, your care needs,and to ask questions about your care.

1114. To participate or have your designatedrepresentative participate in the considerationof ethical issues which arise in your care.15. To exercise cultural and spiritual beliefsthat do not interfere with the well being ofothers.Choice1. To express choice regarding servicedelivery, composition of the service team andconcurrent services.2. To request that another physician treatyou in the event that you are not satisfied withthe medical treatment you are receiving from aparticular physician. However, the physicianyou select is free to accept, or not accept, thetransfer of your care to him/her and you musthave the benefit of complete information andexplanation concerning the risks, benefits andalternatives to transferring your care to anotherphysician.3. To transfer to another facility whenmedically appropriate or upon your request.However, the receiving facility must firstaccept the transfer, and you must also havethe benefit of complete information andexplanation concerning the risks, benefits, andalternatives to such transfer.4. To recieve visitors and to deny visitors.(Health Care Proxy) or to have a legallyappointed guardian make or communicatedecisions on your behalf.3. To refuse to serve as a research subject,and to refuse any care or examinationwhen the primary purpose is educational orinformational rather than therapeutic. A patientwho accepts participation has the right to havethe proposed studies fully explained prior toconsent. A patient who declines participationis nonetheless entitles to the most effectivecare atht SHC can provide.Information1. To obtain from physicians and otherdirect care givers, relevant and currentinformation that you can reasonably beexpected to understand. When it is notmedically possible to provide you with suchinformation, the information should be madeavailable to an appropriate person on yourbehalf.2. To obtain from a person designated bySHC, a copy of any rules and regulations ofSHC that apply to your conduct as a patient.3.To review and obtain, upon request, acopy of your medical record for a reasonablefee and within a reasonable time frame. Tohave such information explained or interpretedas necessary, except when restricted by law.Consent or RefusalTo request amendment to health information1. To receive an adequate explanation ofand obtain information on disclosures of youryour health problems, the proposed treatment, health information in accordance with law andand the risks and benefits of treatment, so that regulation.you may give voluntary and well informed4. To be informed of SHC policies andconsent. You also have the right to have yourpractices that relate to patient care, treatmentquestions answered and long term financialor responsibilities.implications of treatment choices explained, in5. To be informed of available resources forso far as they are known, except in emergency resolving disputes, grievances and conflicts,situations.such as the Director of Quality and Compliance.2. To designate an agent to make health6.To receive from a person designated bycare decisions for you in the event you can no SHC, upon request, any available informationlonger make or communicate such decisionsthat the facility has relative to financial

assistance, payments and free care.7. To receive upon request, a copy of anitemized bill or statement of charges submittedto a third party payor.8.To notification, upon request, of youreligibility for reimbursement by any thirdparty payor for the cost of your care.9. To obtain, upon request, an explanationas to the relationship, if any, between SHCand any other health care institution, facilityor educational institution as long as saidrelationship relates to care or treament.10.

Spaulding Hospital for Continuing Medical Care Cambridge 1575 Cambridge St. Cambridge, MA 02138 (617) 876-4344 Unit specific extensions: 2 West ext. 7915 2 South ext. 3432 3 West ext. 3423 3 South ext. 3433 4 West ext. 3425 4 South ext. 3434 YOUR TREATMENT TEAM When you are admitted, a Spaulding attending physician is assigned to your care.