PROCEDURE FOR DNR AND POST ORDERS

PROCEDURE FOR DNR AND POST ORDERS

ag5341Adopted July 9, 2019

5341 - PROCEDURE FOR DNR AND POST ORDERS

This guideline addresses the procedures for emergency management of students who have a Do Not Resuscitate (“DNR”) Agreement or a Physician Order for Scope of Treatment (“POST”) form.

Pursuant to I.C. 16-36-5-11, a DNR order must be executed by either a person who is at least eighteen (18) years old and is competent or by a representative of a person who is at least eighteen (18) years old and has been determined incompetent. A DNR order may not be executed for a person who is less than eighteen (18) years old. If the student meets the criteria for the execution of a DNR order and the DNR order has been provided to the school or an out of hospital DNR identification device is worn by the student or in the student's possession, staff members shall comply with the terms of the order and shall not administer cardiopulmonary resuscitation (“CPR”) in the event of a medical emergency. Instead, staff members shall call 911 to report the medical emergency and shall advise the emergency management personnel who respond of the existence of the DNR order. In addition to calling 911, staff members shall notify the student’s parent or guardian of the medical emergency as soon as practicable.

The following individuals may complete a POST form:

  1. A qualified person who is either at least eighteen (18) years of age or less than eighteen (18) years of age but authorized to provide consent under I.C. 16-36-1-3(a)(2) and of sound mind.
  2. A qualified person's representative, if the qualified person is less than eighteen (18) years of age and is not authorized to consent under I.C. 16-36-1-3(a)(2) or has been determined to be incapable of making decisions about the qualified person's health care by a treating physician acting in good faith and the representative has been:
     
    1. appointed by the individual under I.C. 16-36-1-7 to serve as the individual's health care representative;
    2. authorized to act under I.C. 30-5-5-16 and I.C. 30-5-5-17 as the individual's attorney in fact with authority to consent to or refuse health care for the individual;
    3. appointed by a court as the individual's health care representative under I.C. 16-36-1-8; or
    4. appointed by a court as the guardian of the person with the authority to make health care decisions under I.C. 29-3.

A "qualified person" is an individual who has at least one (1) of the following:

  1. An advanced chronic progressive illness.
  2. An advanced chronic progressive frailty.
  3. A condition caused by injury, disease, or illness from which, to a reasonable degree of medical certainty:
     
    1. there can be no recovery; and
    2. death will occur from the condition within a short period without the provision of life-prolonging procedures.
  4. A medical condition that, if the person were to suffer cardiac or pulmonary failure, resuscitation would be unsuccessful or within a short period the person would experience repeated cardiac or pulmonary failure resulting in death.

The treating physician and qualified person or representative must sign and date the POST form for the POST form to be effective. The POST form must include the following:

  1. A medical order specifying whether CPR should be performed if the qualified person is in cardiopulmonary arrest.
  2. A medical order concerning the level of medical intervention that should be provided to the qualified person, including the following:
     
    1. Comfort measures.
    2. Limited additional interventions.
    3. Full intervention.
  3. A medical order specifying whether antibiotics should be provided to the qualified person.
  4. A medical order specifying whether artificially administered nutrition should be provided to the qualified person.
  5. A signature line for the treating physician, including the following information:
     
    1. The physician's printed name.
    2. The physician's telephone number.
    3. The physician's medical license number.
    4. The date of the physician's signature.

"Signature" includes an electronic or physician controlled stamp signature.

  1. A signature line for the qualified person or representative, including the following information:
     
    1. The qualified person's or representative's printed name.
    2. The relationship of the representative signing the POST form to the qualified person covered by the POST form.
    3. The date of the signature.
  2. A section presenting the option to allow a declarant to appoint a representative (as defined in I.C. 16-36-1-2) under I.C. 16-36-1-7 to serve as the declarant's health care representative.

If the POST form has properly been executed and presented to the school, staff members, including the school nurse, shall comply with the terms of that order unless the staff member:

  1. believes the POST form was not validly executed;
  2. believes in good faith that the declarant, the representative, or another individual at the request of the declarant or representative has revoked the POST form;
  3. believes in good faith that the declarant or representative has made a request for alternative treatment;
  4. believes it would be medically inappropriate to provide the intervention included in the declarant's POST form; or
  5. has religious or moral beliefs that conflict with the POST form.

In the case of a religious or moral objection, a health care provider, including the school nurse, must transfer care of the student to another health care provider who is able to implement or carry out the orders. In all cases, staff members shall call 911 to report the medical emergency and shall advise the emergency management personnel who respond of the existence of the POST form. In addition to calling 911, staff members shall notify the student’s parent or guardian of the medical emergency as soon as practicable.

© Neola 2019