Serious accidents and medical emergencies can happen without notice and leave people unable to participate in the most important decisions of thier lives. The Nebraska Emergency Treatment Orders (NETO for short) is a simple one-page document that can speak for you when you can't speak for yourself. Many people have various forms of "advance directives" but experience shows they don't work the way people expect. The NETO was developed by Nebraska physicians and attorneys to meet the needs of the people of our state.
Licensed Medical Providers can get information here about how to use NETO in your practice or facility
People who want to use NETO in your community can get information here about building a system of care
A NETO converys your treatment choices if you are unable to make decisions for yourself. It is a bright yellow piece of paper that contains your witnessed declaration to accept, limit, or refuse medical treatment on one side and an attestation and medical orders for EMS or other first responders on the other side. The declaration is in the form of four standardized questions that match the needs of a patient as they experience a medical emergency that leaves them unable to make or communicate thier own decisions.
This form was designed to be created by a person in collaboration with a physician, nurse practitioner or physcians assistant. This helps assure that people understand their choices in the context of thier personal health status. The physician attests that they have talked to the patient about thier choices, that they seem to understand them and that they had the ability to make medical decisions at the time it was signed.
When you call 911 emergency responders rush out with orders to administer medical life sustaining treatments if they are required. They assume that if you called 911 you want everything they can do. If you DON'T want CPR, Intubation or to be transported to the hospital the EMS providers need orders from another physician to suspend thier protocols. This section clearly states if you DO or DO NOT want each of these three options and provides EMS with the orders they need.
NETO was designed to be revised with a simple visit to your doctor. While many decisions will last for years, changes in health or family status can lead to changes in your choices. The most recently signed and dated NETO prevails.
Good decisions lead to appropriate care, but those decision have to be communicated across a whole community to make sure we respect patient choices. This section details some of the ground work required to assure your community is ready to start using NETO.
It is best to collect a group of engage community members from across the spectrum of care. Consider including representatives from the hospital, EMS, physicians, nursing facilities, churches and organizations who advocate for the elderly or specific illness populations. Work toward building consensus about the need to improve continuity of care and adherence to patient wished for emergency treatment. Think about a communication plan to reach out to the rest of the community. Set targets to mark your progress. How many doctors have signed on to participate? How many facilities? What percnetage of the population have a NETO? These are all metrics you could follow to guage teh success of your program .
In order for the NETO to be effective you need three key pieces in place:
With at least these three elements in place you are ready to start a small scale trial.
Hospitals and facilites will need to know how to handle the new forms. Though the NETO is new, it fits the description of and Advanced DIrective, so should be handled in the same manner. The Patient Self Determination Act of 1991 requires that all healthcare facilities accept and honor a patients directives. Even so, they will need to plan for how it will be handled in thier systems. They may want to look at thier "code status" policies to make sure that the signed NETO will be honored at the time of admission. Since the NETO is designed to improve continuity, it may be initiated in the hospital prior to discharge, or an existing form may be revised in the hospital after a patient receives more information about thier illness. Appropriate policies and procedures may need to be developed.
The NETO forms and educational materials have been developed free of charge to users who are welcome to print them in thier community. Started packs of material are available through:_____ To preserve uniformity and standardization, no alteration may be made to the form. Any suggestions for improvement should be made to the founding committee.
The NETO is currently being piloted in Omaha and the surrounding communities. If you'd like more information, please feel free to contact us.