Dpoah Question

[lisa41rn]

I'm still a fairly new nurse and have a question on DPOAHs. I had a patient admitted with exacerbation of COPD. He was transferred from another floor. For whatever reason, a friend showed up with a copy of the DPOAH upon admission to our floor and I placed the copy in the chart, but the doctor never activated the DPOAH. Well, this friend/DPOAH expected to be updated on the patients condition. As I just got a quick report, it seems the patient probably knew as much as I did. He was completely A&O and was told about his condition.

This patient came to the floor at the worst time (what's new?). It was nearing the end of a shift, I had to get a D/C done and transfer a patient at the same time. Once I knew my new patient was okay, I was working on the latter two tasks and went back to the patient to speak with him again. In between my walking around I had this friend be very rude because I wasn't giving him info he wanted except to ask him to speak with his friend. It was just a strange situation. I know, I know I shouldn't judge, but I didn't trust this guy at all.

Anyway, my question is, unless a doctor activates a DPOAH do we have to update the DPOAH if they bring in legal documents on a patient's condition? I would think until it is activated by the doc, he needs to speak with the patient (who is capable) for the updates unless the patient tells us otherwise. I did look in the chart upon the patients admission to our floor and found no one's name as a contact including this friend so eager to gain info. Thanks everyone!

[elkpark]

Your understanding is correct. The difference between a DPOA and a guardianship is that, when someone is declared incompetent and a guardian is appointed, the person (patient) no longer has any legal standing/ability to give or withhold consent and the guardian is responsible for receiving all information and making all decisions on the person's behalf, 24/7.

A DPOA for healthcare only takes effect when/if the person who executed it (the patient) becomes unable (for whatever reason) to make or communicate decisions regarding healthcare, and is only in effect until the person regains the ability to make her/his own decisions known (if that occurs). As you note, deciding that the person has become unable to make/communicate decisions and the DPOA should be "activated" is a medical decision, not a legal one (another difference between a guardianship and a DPOA). However, until the DPOA is activated, the person named in the DPOA is, legally, the same as any other friend/visitor -- no special access to protected information, unless you have a consent from the patient that s/he wants you to discuss info with this other person. It the patient is A&O and interacting, you are correct to refer the friend to the patient.

Regular "people on the street" are typically not at all clear on the fine points of guardianships and DPOAs, so it may well be that this other person means well but just doesn't understand how the DPOA works -- but you are definitely doing the right thing.

[Daytonite, BSN, RN]

Lisa,

Do you have a risk management department, office or person in the hospital you are working? If not, social services should be contacted and asked about this. I have a DPOAH and it specifically states that my POA takes over only when I am incapable to do so myself. If I were the patient I sure would want to know if someone had come in with one of my DPOAH documents and was lurking around demanding information about me. My Odd Ball Alarm went off as I read your post. This supposed POA is not acting right. Perhaps he just doesn't understand the nature of what he volunteered for. Did you talk to the patient about this? It is possible that the patient may have changed his original DPOAH or perhaps even voided it. Then, again, you can't always know what the relationship between these two people is. That's why I think you should ask risk management or social services to get involved here. Call them when you get home if they're not in their office when you leave in the mornings. They just might want to know about this guy.

Joyce