Nebraska Emergency Treatment Orders (NETO), advance care planning

Nebraska Emergency Treatment Orders (NETO), advance care planning

Nebraska Emergency Treatment Orders (NETO), advance care planningNebraska Emergency Treatment Orders (NETO), advance care planning

Emergency Medical Providers

EMS provides life sustaining treatment guided by pre-approved protocols. The NETO Orders  provide clear, unambiguous medical orders for EMS to depart from protocol when patients have refused CPR, Intubation and/or Transport. 

Emergency Department Providers

The NETO Declaration summarizes the patient's directives for scope of initial treatment and code status  if  a seriously ill patient requires  treatment but is unable to make decisions. It gives direction to both medical providers and surrogates.

Hospitals and Facilites

NETO is an advance directive, so most policies and procedures are in place to handle the forms.  Unlike other advanced directives, this form is explicitly designed to direct emergency treatment, so ED and Admission procedures may have to be adjusted. 

Ambulatory Doctors, APRNs, PAs

Most planning should happen while patients are stable with the advice of a doctor who knows them. The Patient Guide  describes the choices available. Other handouts provide more detail. 

Clinician Guide to NETO

This fact filled clinician guide will answer many questions about the NETO form and process. If you are printing this, use 11x17 paper and fold in half. 

General Information About NETO

image1

What is NETO?

NETO is a bright yellow  two-sided document that combines  a Declaration to accept, limit or refuse treatment on one side, and physician orders for EMS on the other side. The declaration answers four questions that guide treatment if the patient can't make decisions. It was developed to promote planning and continuity of care, and to provide a standard document that fits Nebraska's existing laws. It was created by a group of Nebraska physicians and lawyers who wanted to improve care. The Nebraska Health Network funded the production of the forms and media.

image2

Four Questions the Patient Answers

The declaration is divided into four sections: 

  1. Scope of Treatment Desired (three responses)
  2. Stopping Treatment (common reasons for stopping treatment)
  3. Resuscitation Status for Cardiac Arrest (yes or no)
  4. Long Term Medically Administered Nutrition (yes or no)

image3

Three Orders and an Attestation

The orders for EMS:

  1. CPR (yes or no)
  2. Intubation (yes or no)
  3. Transport to hospital (yes or no)

The Attestation:

Medical provider attests that the patient had capacity to make decisions when the orders were written and that the orders are based on the patients declaration.

Resources for Helping Patients Plan

image4

The Conversation Project

The National Center for Ethics In Healthcare Life sustaining treatment initiative