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Living
wills have an impact on pre-hospital
lifesaving care
A study conducted at the Hamot Medical
Center in Erie, Pennsylvania shows that
there is a lack of education and
understanding in what sets a living will in
motion in a pre-hospital setting.
Education and implementation of code status
designations can clarify this confusion.
The use of living wills and their impact on
patient care had not been adequately
studied. Living wills have the potential to
impact patient care for patients who call
911 in a medical emergency.
The study aimed to determine how a living
will is interpreted and assess how
interpretation impacted lifesaving care.
Researchers Mirarchi, et.al., found that
significant confusion and concern for
patient safety exists in the pre-hospital
setting due to the understanding and
implementation of living wills and DNR (do
not resuscitate) orders.
When a living will is present with the
patient experiencing a critical illness, it
has the potential to limit or delay
lifesaving care.
This confusion can be mitigated by
implementing clearly defined code status
into the living will.
"The results of the study are important
because they provide clarification as to
when a living will is enacted and promotes
patient care and safety.
It ensures the provision of lifesaving care
for those who call 911 for a medical
emergency," according to lead researcher
Ferdinando L. Mirarchi, DO, FAAEM, FACEP.
The results of this study suggest that the
current structure of the living will leads
the majority of pre-hospital health care
providers to incorrectly assume a patient is
a DNR.
Living wills should not be considered
synonymous with DNR orders.
DNR is misunderstood to define comfort
care/end-of-life care, a confusion that can
compromise lifesaving care.
This confusion and concern for patient
safety can be rectified by incorporating a
clearly defined code status designation
within the living will.
Educational efforts and provider protocols
must be reevaluated and implemented to
ensure patient safety.
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