IPOST
1
In the hospital,
any patient
with a terminal
illness—regardless
of age—can
be protected
against unwanted
resuscitation
by a DO NOT
RESUSCITATE
order (DNR). If
such a patient
is younger than
18, this order is
agreed upon
by the patient,
guardian(s)
and physician.
, IOWA PHYSICIAN ORDERS FOR SCOPE OF TREATMENT
FACTS SHEET
2
NE
POLST
in progress
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07/2012
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Many of
Iowa’s
healthcare
providers may be
unfamiliar with
the IPOST law and
the IPOST form
to summarize
patient treatment
preferences.
They may also be
unfamiliar with
how to access,
complete and use
the form.
4
5
In 2010,
surveys
of the
Iowa chapter of
the American
Academy of
Pediatrics and
Iowa EMS
providers indicated
strong support for
a change in Iowa’s
out-of-hospital Do
Not Resuscitate
(DNR) policy to
protect terminally
ill pediatric
patients.
This call
for change
resulted
in the IPOST law,
which protects
all terminally ill
and medically
fragile Iowans,
regardless of age,
from unwanted
resusciatation.
Effective
July 1, 2012,
the Iowa
Physician Orders
for Scope of
Treatment (IPOST)
law provides
similar protections
for Iowans as the
Physician Orders
for Life-Sustaining
Treatment (POLST)
laws in other
states.
An IPOST order
converts patient
preferences into orders
that are accessible to medical
providers, including EMS, in
any setting. For terminally
ill children under age 18, an
IPOST DNR order form will
protect against unwarranted
resuscitation in the out of
hospital setting. An associated
IPOST DNR Medic Alert
identifier is recommended.
The IPOST
law was
created
to honor the
healthcare
treatment choices
of individuals
and to protect
against unwanted
resuscitation
attempts at end of
life.
9
.
IA
IPOST,
July 2012
KS
Under the
IPOST law,
Iowa’s
children with
terminal illness
can now access
protection
against unwanted
resuscitation in
the out-of-hospital
setting, if desired.
3
In many states,
including Wisconsin,
Illinois, Missouri,
and Kansas, terminally ill
patients — regardless of
age — are protected against
unwanted resuscitation in
the out-of-hospital setting by
Physician Orders for
Life-Sustaining
Treatment
(POLST) or other
WI
similar policies. n
IL
POLST
in progress
MO
8
For more
information
about caring for
terminally ill or
medically fragile
children, see the
Partnership for
Parents website at:
www.partnership
forparents.org
.
For more
information
about the IPOST:
www.idph.state.
ia.us/ems
IPOST
, IOWA PHYSICIAN ORDERS FOR SCOPE OF TREATMENT
FREQUENTLY
ASKED QUESTIONS
. What is the Iowa Physician Orders for Scope of
Treatment (IPOST) form?
Based on the IPOST law, the IPOST form is a tool that
consolidates and summarizes an individual’s preferences for
life-sustaining treatments and interventions and may be relied
upon across medical settings.1
. Who can have an IPOST?
Any individual who is frail and elderly or who has a chronic,
critical medical condition or a terminal illness and for which
a physician orders for scope of treatment (IPOST) form is
consistent with the individual’s goals of care can have an
IPOST.2
. What does terminal illness mean?
Terminal illness 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.2
. What is resuscitation?
Resuscitation includes any medical intervention that utilizes
mechanical or artificial means to sustain, restore, or supplant
a spontaneous vital function, including but not limited to:
chest compressions, defibrillation, endotracheal intubation
or emergency drugs to alter cardiac or respiratory function or
otherwise sustain life.3
. What does “unwarranted resuscitation” mean?
Unwarranted resuscitation means any medical intervention
to sustain vital function by mechanical or artificial means
in a patient with a terminal condition who has chosen to
allow natural death.3 CPR was never intended for terminally
ill patients and, for many patients with chronic, debilitating
illnesses, cannot be performed successfully.
07/2012
. What is comfort care?
Comfort care may include, but is not limited to: pain
medication; fluid therapy; respiratory assistance (for instance,
oxygen and suctioning). 3
. Without IPOST protection, what happens if a
terminally ill child dies at home?
Although children enrolled in hospice may be protected
against unwanted interventions, if EMS responds and finds a
child pulseless and/or not breathing, full resuscitation must
be attempted with CPR and transport to a hospital. A medical
examiner and law enforcement assessment of the events
surrounding the child’s death at home will be performed.
. Why don’t all terminally ill children utilize the hospice
benefit?
In rural states like Iowa, hospice is not able to cover the needs
of all counties. In addition, very few hospice providers are
trained to care for children at the end of life.
. Can an IPOST DNR order be revoked?
An IPOST form may be revoked at any time and in any manner
by which the patient or patient’s legal representative is able to
communicate the patient’s intent to revoke, without regard to
the patient’s mental or physical condition.1
. What is the role of EMS for a terminally ill patient with
an IPOST?
The role of EMS, if called, is to provide support and comfort
care at end of life while honoring the patient’s IPOST.
1 Iowa Administrative Code 641-142.1(144A, IPOST)
2 Iowa Administrative Code 641-142.1(144A.2, 13)
3 Iowa Administrative Code 641-142.7 [Appendix B]