Current through Register Vol. 46, No. 19, March 20, 2024
In order to encourage understanding and implementation of OOH
DNR orders and protocols throughout Iowa and honor a qualified patient's wishes
and intent regarding the provision of life-sustaining procedures in an
out-of-hospital setting consistent with the requirements of Iowa Code chapter
144A, the following guidelines should be considered.
(1)
Attending physicians or attending
physician assistants who issue OOH DNR orders. The attending physician
or attending physician assistant should ensure that the following are
accomplished:
a. Establish that the patient is
qualified because the patient:
(1) Is an
adult; and
(2) Has a terminal
condition.
b. Explain to
the patient or the individual legally authorized to act on the patient's behalf
the implications of an OOH DNR order.
c. If the qualified patient or individual
legally authorized to act on the patient's behalf decides that the patient
should not be resuscitated, the attending physician or attending physician
assistant may issue the OOH DNR order on the prescribed uniform order form. The
order will direct health care providers to withhold or withdraw
resuscitation.
d. Explain to the
qualified patient or the individual legally authorized to act on the patient's
behalf how the OOH DNR order is revoked.
e. Include a copy of the order in the
qualified patient's medical record.
f. Provide a copy of the order to the
qualified patient or the individual legally authorized to act on the patient's
behalf.
(2)
Qualified patients or legally authorized persons. A qualified
patient or a person legally authorized to act on a qualified patient's behalf
should:
a. Make an informed decision
concerning resuscitation in the face of a terminal condition.
b. Ensure that the qualified patient's family
members are aware of this decision and inform them of the location of the OOH
DNR order and the purpose of an OOH DNR identifier.
c. Understand the process for revocation as
described in rule 641-142.6
(144A).
(3)
Non-EMS health care providers. A non-EMS health care provider
contemplating resuscitation for a patient should:
a. Evaluate the patient's status and needs
through an assessment consistent with the provider's training, certification
and licensure.
b. Determine that
the presenting condition is within the scope of the patient's terminal
condition and is not the result of a motor vehicle collision, fire, mass
casualty or other cause of a sudden accident or injury.
c. Determine the existence of an OOH DNR
order or that the patient is wearing an OOH DNR identifier.
d. Honor the OOH DNR order or OOH DNR
identifier worn by the patient.
e.
Discontinue resuscitation if the OOH DNR order or OOH DNR identifier worn by
the patient is discovered after resuscitation has begun.
f. Provide comfort care to the patient at all
times.
g. If uncertainty exists
regarding the validity or applicability of the OOH DNR order or identifier, the
health care provider shall provide the necessary and appropriate
resuscitation.
h. Document
compliance or noncompliance with the OOH DNR order and the reasons for not
complying with the order, including evidence that the order was revoked or
uncertainty regarding the validity or applicability of the order or OOH DNR
identifier.
(4)
Hospitals. A hospital licensed under Iowa Code chapter 135B:
a. Shall not be precluded from honoring an
OOH DNR order entered in accordance with this chapter and in compliance with
established hospital policies and protocols.
b. Should, to avail itself of the immunities
provided within Iowa Code chapter 142, establish such policies and protocols to
address an OOH DNR order or identifier encountered on a person who presents to
the emergency department or in any other area within the facility if the person
presents as a patient or visitor.
c. Should integrate policies and procedures
with the OOH DNR protocol for hospital-based ambulance service programs, if
present.
(5)
Other health care organizations. A nursing home, home health
care agency, hospice, or other health care organization should establish
policies and protocols consistent with these rules to address admitted patients
who have OOH DNR orders.
