Advance Care Planning

Pediatrics

For Clinicians (Calgary Zone)

Policy

Policy 1636: Advance Care Planning: Goals of Care Designation (Pediatric)

replaces Policy 1614: Resuscitation of Infants, Children and Youths effective September 29, 2009. Policy 2-R-1: Resuscitation and Immediate Care of the Newborn remains in place for Delivery Room resuscitation.

Training

Online Learning Module

A web based, self-learning module (30 minutes) is available on the AHS (Calgary Zone) network, but not from home:

Clinical Forms

Two clinical forms support the policy and are available from our forms supplier:

Pediatric Goals of Care Tracking Record (Form #103767) - a document to track Goals of Care conversations between families and their care providers.
Pediatric Goals of Care Designation Order (Form #103768) - the order, signed by a physician, to document the care decision.

Policy Support Materials

R, M, C, Defined - this is the back page of the Pediatric Goals of Care Designation Order. It explains the Goals of Care Designations in detail.

Pediatric Goals of Care Designations: Quick Reference Guide (Form #103944) - an 8.5" x 11" poster summarizing R, M, and C designations for your clinical area.
Pediatric Goals of Care: Quick Reference Pocket Card (Form # 103945) - a wallet size summary of the designations and the core elements of Goals of Care conversations.

Canadian Paediatric Society Position Statements:

B 2008-02: Advance care planning for paediatric patients
www.cps.ca/english/statements/B/b08-02.htm
B04-01: Treatment decisions regarding infants, children and adolescents
www.cps.ca/english/statements/B/b04-01.htm

Family Support Resources

"Advance Care Planning: Understanding Goals of Care in Pediatrics" - A brochure for families who are having goals of care conversations with their healthcare team. Available Fall 2009
"Hear My Voice" - an activity for families who are coping with a potential life threatening illness to encourage them to talk about their values and goals to guide decision making during the illness experience.

We would really like to hear your thoughts and suggestions about the activity. Please click here and complete a very short on-line survey.
"Hear My Voice" - Family Notes - a document for families to record their thoughts after participating in the "Hear My Voice" activity.

For more information on Advance Care Planning and the Pediatric Goals of Care Designation Policy please contact

Sharron Spicer, MD, FRCPC at (403) 955-5466

or e-mail us at:

myvoice@albertahealthservices.ca

Advance Care Planning Home Current Highlights Advance Care Planning: Goals of Care Designation Policy Background Advance Care Planning Tools Goals of Care & Goals of Care Designations Forms & Processes Education Resources FAQ's Related Publications, Reports & Research Pediatrics Links Contact Us Online Learning Module You must access WBT from an AHS computer Pediatric Policy Module	Advance Care Planning Pediatrics For Clinicians (Calgary Zone) Policy Policy 1636: Advance Care Planning: Goals of Care Designation (Pediatric) replaces Policy 1614: Resuscitation of Infants, Children and Youths effective September 29, 2009. Policy 2-R-1: Resuscitation and Immediate Care of the Newborn remains in place for Delivery Room resuscitation. Training Online Learning Module A web based, self-learning module (30 minutes) is available on the AHS (Calgary Zone) network, but not from home: Physician Instruction Sheet Staff Instruction Sheet Quick link to WBT Clinical Forms Two clinical forms support the policy and are available from our forms supplier: Pediatric Goals of Care Tracking Record (Form #103767) - a document to track Goals of Care conversations between families and their care providers. Pediatric Goals of Care Designation Order (Form #103768) - the order, signed by a physician, to document the care decision. Policy Support Materials R, M, C, Defined - this is the back page of the Pediatric Goals of Care Designation Order. It explains the Goals of Care Designations in detail. Pediatric Goals of Care Designations: Quick Reference Guide (Form #103944) - an 8.5" x 11" poster summarizing R, M, and C designations for your clinical area. Pediatric Goals of Care: Quick Reference Pocket Card (Form # 103945) - a wallet size summary of the designations and the core elements of Goals of Care conversations. Canadian Paediatric Society Position Statements: B 2008-02: Advance care planning for paediatric patients www.cps.ca/english/statements/B/b08-02.htm B04-01: Treatment decisions regarding infants, children and adolescents www.cps.ca/english/statements/B/b04-01.htm Family Support Resources "Advance Care Planning: Understanding Goals of Care in Pediatrics" - A brochure for families who are having goals of care conversations with their healthcare team. Available Fall 2009 "Hear My Voice" - an activity for families who are coping with a potential life threatening illness to encourage them to talk about their values and goals to guide decision making during the illness experience. We would really like to hear your thoughts and suggestions about the activity. Please click here and complete a very short on-line survey. "Hear My Voice" - Family Notes - a document for families to record their thoughts after participating in the "Hear My Voice" activity. For more information on Advance Care Planning and the Pediatric Goals of Care Designation Policy please contact Sharron Spicer, MD, FRCPC at (403) 955-5466 or e-mail us at: myvoice@albertahealthservices.ca
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