Iowa Code 144A.7A – Out-of-hospital do-not-resuscitate orders
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1. If an attending physician or attending physician assistant issues an out-of-hospital do-not-resuscitate order for an adult patient under this section, the physician shall use the form prescribed pursuant to subsection 2, include a copy of the order in the patient’s medical record, and provide a copy to the patient or an individual authorized to act on the patient’s behalf.
Terms Used In Iowa Code 144A.7A
- Adult: means an individual eighteen years of age or older. See Iowa Code 144A.2
- Attending physician: means the physician selected by, or assigned to, the patient who has primary responsibility for the treatment and care of the patient. See Iowa Code 144A.2
- Attending physician assistant: means the physician assistant selected by, or assigned to, the patient who has primary responsibility for the treatment and care of the patient. See Iowa Code 144A.2
- Department: means the Iowa department of public health. See Iowa Code 144A.2
- Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
- following: when used by way of reference to a chapter or other part of a statute mean the next preceding or next following chapter or other part. See Iowa Code 4.1
- Health care provider: means a person, including an emergency medical care provider, who is licensed, certified, or otherwise authorized or permitted by the law of this state to administer health care in the ordinary course of business or in the practice of a profession. See Iowa Code 144A.2
- Hospital: means hospital as defined in section 135B. See Iowa Code 144A.2
- Out-of-hospital do-not-resuscitate order: means a written order signed by a physician, executed in accordance with the requirements of section 144A. See Iowa Code 144A.2
- Person: means a natural person. See Iowa Code 154A.1
- Physician: means a person licensed to practice medicine and surgery or osteopathic medicine and surgery in this state. See Iowa Code 144A.2
- Physician assistant: means a person licensed to practice as a physician assistant in this state. See Iowa Code 144A.2
- Resuscitation: means any medical intervention that utilizes mechanical or artificial means to sustain, restore, or supplant a spontaneous vital function, including but not limited to chest compression, defibrillation, intubation, and emergency drugs intended to alter cardiac function or otherwise to sustain life. See Iowa Code 144A.2
- Signature: includes an electronic signature as defined in section 554D. See Iowa Code 4.1
- Terminal condition: means an incurable or irreversible condition that, without the administration of life-sustaining procedures, will, in the opinion of the attending physician, result in death within a relatively short period of time or a state of permanent unconsciousness from which, to a reasonable degree of medical certainty, there can be no recovery. See Iowa Code 144A.2
2. The department, in collaboration with interested parties, shall prescribe uniform out-of-hospital do-not-resuscitate order forms and uniform personal identifiers, and shall adopt administrative rules necessary to implement this section. The uniform forms and personal identifiers shall be used statewide.
3. The out-of-hospital do-not-resuscitate order form shall include all of the following:
a. The patient’s name.
b. The patient’s date of birth.
c. The name of the individual authorized to act on the patient’s behalf, if applicable.
d. A statement that the patient is in a terminal condition.
e. The physician’s or physician assistant‘s signature.
f. The date the form is signed.
g. A concise statement of the nature and scope of the order.
h. Any other information necessary to provide clear and reliable instructions to a health care provider.
4. A health care provider may withhold or withdraw resuscitation outside a hospital consistent with an out-of-hospital do-not-resuscitate order issued under this section and the rules or protocols adopted by the department.
5. In fulfilling the instructions of an out-of-hospital do-not-resuscitate order under this chapter, a health care provider shall continue to provide appropriate comfort care and pain relief to the patient.
6. An out-of-hospital do-not-resuscitate order shall not apply when a patient is in need of emergency medical services due to a sudden accident or injury resulting from a motor vehicle collision, fire, mass casualty, or other cause of a sudden accident or injury which is outside the scope of the patient’s terminal condition.
7. An out-of-hospital do-not-resuscitate order is deemed revoked at any time that a patient, or an individual authorized to act on the patient’s behalf as designated on the out-of-hospital do-not-resuscitate order, is able to communicate in any manner the intent that the order be revoked, without regard to the mental or physical condition of the patient. A revocation is only effective as to the health care provider upon communication to that provider by the patient, an individual authorized to act on the patient’s behalf as designated in the order, or by another person to whom the revocation is communicated.
8. The personal wishes of family members or other individuals who are not authorized in the order to act on the patient’s behalf shall not supersede a valid out-of-hospital do-not-resuscitate order.
9. If uncertainty regarding the validity or applicability of an out-of-hospital do-not-resuscitate order exists, a health care provider shall provide necessary and appropriate resuscitation.
10. A health care provider shall document compliance or noncompliance with an out-of-hospital do-not-resuscitate 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.
11. This section shall not preclude a hospital licensed under chapter 135B from honoring an out-of-hospital do-not-resuscitate order entered in accordance with this section and in compliance with established hospital policies and protocols.