Medical Staff House Staff Orientation Manual - Montefiore Medical ...

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Patients for whom a DNR based on medical futility is appropriate must meet, one of the following criteria: • the patient will not survive a code, or • the patient will experience multiple arrests in a short period of time. WHEN: DNR applies only at the time of cardiac and/or pulmonary arrest and does not affect or limit any other care. WHERE: • DNR orders are valid in every inpatient clinical setting. • Non-hospital DNR orders are valid in any community or ambulatory care setting. • Suspension of a DNR order in the OR or other department must be discussed with a capacitated patient or the health care agent or DNR surrogate of a patient without capacity. Before a DNR order is suspended for a procedure in the OR or other department, the reasons for and duration of the suspension must be discussed with the person giving consent. The decision must be documented by both the attending surgeon and attending anesthesiologist and their agreement with patient, agent or surrogate fully communicated to the health care team. HOW: The DNR protocol includes documenting on the appropriate forms (see below):: • determination of patient suitability • determination of patient’s decisional capacity • discussion with patient, health care agent or surrogate • obtaining verbal or written consent to DNR. Verbal consent must be documented and witnessed by 2 people. • entering DNR order in the medical record or on CIS • notification of patient, health care agent or surrogate If the patient lacks decisional capacity, a DNR order may only be consented to by a health care agent or DNR surrogate based on one of the following 4 criteria: • terminal condition, or • permanent unconsciousness, or • medical futility (patient would not survive resuscitation or • would survive but would have multiple arrests within a short period of time (see above), or extraordinary burden (CPR would cause more harm than benefit). DNR forms are available on all clinical units • OD1091-1 DNR Attending Physician’s Documentation (3 pages-pink) • OD1091-2 Oral Consent to DNR Order (single page-pink, requires 2 witnesses, one of whom is a physician) • OD1091-3 Written Consent to DNR Order (single page-pink- for patient’s/surrogate’s, in English & Spanish ) 96
• OD1091-4 Affidavit of Close Friend consenting to DNR (single page-pink-- in English Spanish ) • OD1091-5 Nonhospital DNR (single page-white--order for ambulatory care and community settings. Note: After completing the appropriate forms, the attending physician must enter a written or electronic DNR order. Disputes about DNR orders for incapacitated patients trigger a dispute mediation process, during which the DNR is suspended and resuscitation must be attempted in the event of an arrest. When the patient’s attending physician has a conscientious objection to issuing a DNR order for a suitable patient, that physician must transfer the patient to another attending. CONTACT: <strong>Medical</strong> Director’s Office 718- 920-7052 Palliative Care 718- 920-6378 Bioethics (Moses) 718- 920-6226 (Weiler) 718- 904-2299 DO-NOT-INTUBATE (DNI) ORDERS Summary -Administrative Policy and Procedure #JD05.1 Note: This summary contains the key points of this policy and the related procedures. For a complete understanding of all the relevant provisions, it is necessary to thoroughly read the full policy. WHAT: • In a cardiopulmonary arrest a DNR order permits withholding both intubation and other components of CPR. A separate DNI order is not needed. • In situations other than an arrest, such as acute respiratory distress, a separate DNI order is necessary to forego intubation. In practice, many patients will request and will meet the conditions for both DNR and DNI orders but the criteria for consenting to and implementing them are very different. NOTE: Do-not-intubate (DNI) orders are distinct from do-not-resuscitate (DNR) orders and, therefore, are covered under a separate do-not-intubate (DNI) policy. WHO: A DNI order may be considered for : • a capacitated patient whose attending physician determines that a do-not-intubate (DNI) order is medically indicated and recommends this course, or • an incapacitated patient whose attending determines that a DNI order is medically indicated and recommends this course to the health care agent or the family/ surrogate who knows the patient’s wishes about intubation; or 97
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Medical Staff House Staff Orientati
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We would like to take this opportun
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Montefiore’s Institute for Reprod
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TABLE OF CONTENTS SECTION 1- Genera
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Plastic and Reconstructive Surgery
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SECTION 1 • GENERAL INFORMATION 1
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Contract Management Organization (C
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Neurology M 4656 3351 Steuben A 316
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MOSES NURSING STATIONS C 741-2377 P
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M 5584 Lupus Clinic M 5584 Neurolog
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MEDICAL STAFF CREDENTIALING OFFICE
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MONTEFIORE INTEGRATED PROVIDER ASSO
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• Referral by the ED physician is
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HOUSE STAFF OFFICE 150 East 210th S
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• Institutions must have a GME Co
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accreditation, then the institution
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and the conditions under which livi
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• Patient support services, such
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following: counseling, appointment
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Physician Impairment and Drug Abuse
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participants the opportunity to com
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WALDO AVENUE SHUTTLE Those resident
Page 45 and 46: First Year Residents: Assignments o
Page 47 and 48: SECTION III • MONTEFIORE MEDICAL
Page 49 and 50: Administrator: Jennifer Ortiz Medic
Page 51 and 52: Medical Director: Marta Rico, MD, A
Page 53 and 54: 2532 Grand Concourse Bronx, New Yor
Page 55 and 56: Briggs Avenue Academy 3010 Briggs A
Page 57 and 58: Nurse: Maria Campos, LPN Sheila Mon
Page 59 and 60: Gloria Feliciano - Director FRANKLI
Page 61 and 62: ANESTHESIOLOGY Chairman 718-920-280
Page 63 and 64: Director John Fisher, MD 718-920-42
Page 65 and 66: Christine Clarke 718-920-5996 PROGR
Page 67 and 68: SOCIAL PEDIATRICS 3544 Jerome Ave.
Page 69 and 70: Vladimir Kvetan, MD 718-920-5440 De
Page 71 and 72: Residency Program Director Eugene S
Page 73 and 74: No procedure can be performed until
Page 75 and 76: Bronx, New York 10461 Administrativ
Page 77 and 78: Director, Education Programs Rasim
Page 79 and 80: North Central Bronx Hospital 718-51
Page 81 and 82: Arlene Saunders 718-741-2492 Admini
Page 83 and 84: printed name of the referring physi
Page 85 and 86: The radiology department at Jack D.
Page 87 and 88: Pediatric Surgery 718-920-7200 Burt
Page 89 and 90: SECTION V • POLICIES AND PROCEDUR
Page 91 and 92: Note: This summary contains key poi
Page 93 and 94: WHERE: • Advance directives are a
Page 95: • family has moral or religious o
Page 99 and 100: Bioethics (Moses) 718- 920-6226 (We
Page 101 and 102: HOW: • Capacitated patients may r
Page 103 and 104: VERIFICATION OF OPERATIVE PROCEDURE
Page 105 and 106: INFECTION CONTROL PROGRAM Moses Nur
Page 107 and 108: person who feels that he/she may be
Page 109 and 110: CONTROLLED SUBSTANCES IN THE MEDICA
Page 111 and 112: • Practitioners will immediately
Page 113 and 114: One Quality Improvement Plan exists
Page 115 and 116: SECTION VI • SERVICE DEPARTMENTS
Page 117 and 118: Legal Certificates 718-904-3456 Fin
Page 119 and 120: CHILD PROTECTION CENTER The Childre
Page 121 and 122: CME REQUIREMENTS: Attending physici
Page 123 and 124: Hours: Monday - Friday 8:00AM - 5:0
Page 125 and 126: delivery system. Medical record inf
Page 127 and 128: All physician orders whether writte
Page 129 and 130: additional information is uncovered
Page 131 and 132: THE TISHMAN LEARNING CENTER HEALTH
Page 133 and 134: MAILROOM MOSES Brown Zone, Moses Ba
Page 135 and 136: The mission of the Occupational Hea
Page 137 and 138: • Families and caregivers need as
Page 139 and 140: The Patient Safety Officer and the
Page 141 and 142: Unified Director of Pharmacy Frank
Page 143 and 144: successful, expanded to other areas
Page 145 and 146: • Professional Misconduct • Pho
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Outpatient testing, evaluation and
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Office Coordinator Lillian Zambardi
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E Educational Administration 28 Eme
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Paychecks, House Staff 40 Pediatric
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Medical Staff House Staff Orientation Manual - Montefiore Medical ...

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