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DAR File No. 32195

This filing was published in the 01/01/2009, issue, Vol. 2009, No. 1, of the Utah State Bulletin.

Health, Health Systems Improvement, Emergency Medical Services

R426-100

Emergency Medical Services Do Not Resuscitate

NOTICE OF PROPOSED RULE

DAR File No.: 32195
Filed: 12/03/2008, 04:26
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this amendment is to implement a process that will allow emergency responders to recognize and honor the end of life wishes of a person that they serve.

Summary of the rule or change:

Physicians Order for Life Sustaining Treatment and Do Not Resuscitate Order processes are being consolidated into a single Life with Dignity Order. Emergency responders will be allowed to recognize and honor this end of life choice adopted by a person.

State statutory or constitutional authorization for this rule:

Section 75-2a-106

Anticipated cost or savings to:

the state budget:

There may be some costs for printing and training, but these can be covered under existing budgets.

local governments:

Simplifying and consolidating the form should not impose costs on local governments.

small businesses and persons other than businesses:

Simplifying and consolidating the form should not impose costs on small business.

Compliance costs for affected persons:

Simplifying and consolidating the form should not impose costs on individuals.

Comments by the department head on the fiscal impact the rule may have on businesses:

Simplifying and consolidating this form should have no fiscal impact on business. Public comment from facilities and person affected by the rule will be carefully evaluated. David N. Sundwall, MD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Health Systems Improvement, Emergency Medical Services
3760 S HIGHLAND DR
SALT LAKE CITY UT 84106

Direct questions regarding this rule to:

Guy Dansie at the above address, by phone at 801-538-9171, by FAX at 801-538-6808, or by Internet E-mail at gdansie@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

02/02/2009

This rule may become effective on:

02/09/2009

Authorized by:

David N. Sundwall, Executive Director

RULE TEXT

R426. Health, Health Systems Improvement, Emergency Medical Services.

R426-100. [Emergency Medical Services Do Not Resuscitate]Life with Dignity Order.

R426-100-1. Authority and Purpose.

[ This rule implements the prehospital Emergency Medical Services/Do Not Resuscitate (EMS/DNR) provisions of Section 75-2-1105.5 and clarifies that EMS personnel shall also follow a patient's treating physician's orders, which may include an order not to resuscitate a patient that does not comply with the formalities of the EMS/DNR form.

 

R426-100-2. EMS/DNR Forms, Directives, Bracelets, and Necklaces.

(1) Only the Utah Department of Health may create EMS/DNR forms. Each EMS/DNR form must have a state of Utah watermark and a unique identifying number provided by the Department.

(2) The Department shall distribute the EMS/DNR directive forms to any licensed physician as requested.

(3) An EMS/DNR directive is valid only if made on an EMS/DNR form upon which a physician licensed to practice medicine under Part 1 of Chapter 12, Title 58, the Utah Osteopathic Medicine Licensing Act, or under Part 5, of Chapter 12, Title 58, the Utah Medical Practice Act, also makes a determination certifying that the declarant is in a terminal condition.

(4) An EMS/DNR bracelet or necklace may be issued only to individuals whose physician has determined that the declarant is in a terminal condition and who submits an EMS/DNR directive to the Department.

(5) An EMS/DNR bracelet or necklace may only be issued by either the Department or by an entity approved by the Department.

(6) For EMS/DNR bracelets or necklaces issued by a Department-approved entity:

(a) the entity may issue bracelets or necklaces for which the Department has approved the design and construction quality;

(b) the entity may issue an EMS/DNR bracelet or necklace only after verifying with the Department that the individual has submitted a valid EMS/DNR directive to the Department;

(c) the bracelet or necklace shall clearly display:

(i) the words "UTAH EMS - DO NOT RESUSCITATE"; and

(ii) the declarant's EMS/DNR number, or a unique identifying number that the entity links to the declarant's EMS/DNR number;

(7) A Department-approved entity must:

(a) keep a hard copy or an electronically scanned image of each EMS/DNR directive for which it has issued a bracelet or necklace;

(b) be continuously available by toll-free telephone service 24-hours every day, including weekends and holidays that is staffed by an EMT or other licensed health care individual knowledgeable in providing medical care;

(c) immediately send a copy of the EMS/DNR directive to an EMS provider in the field upon request, either by facsimile or in a readily readable electronic format, as requested by the EMS provider; and

(d) verify that the bracelet or necklace matches an EMS/DNR order on file with the entity.

 

R426-100-3. Issuance of an EMS/DNR Directive, or Bracelet, or Necklace.

(1) If the prospective declarant or proxy desires to make an EMS/DNR directive, the physician who makes the determination that the declarant is in a terminal condition must:

(a) explain to the prospective declarant or proxy, and his family, the significance of making an EMS/DNR directive;

(b) complete the information requested on the EMS/DNR form;

(c) sign and date the EMS/DNR form certifying that the declarant is in a terminal condition;

(d) give the original of the directive with the watermark to the declarant or the proxy; and

(e) fill out and give to the declarant or proxy the authorized EMS/DNR bracelet to be placed on the declarant.

(2) The physician or designee, who places the bracelet, must explain to the declarant or proxy how and by whom the EMS/DNR directive may be revoked.

(3) The physician or designee, shall confirm with the Department the execution of the EMS/DNR directive and placement of the EMS/DNR and bracelet or necklace by submitting a duplicate original of the EMS/DNR directive to the Department.

(4) The EMS/DNR directive is effective immediately upon the physician's signing the EMS/DNR directive. The EMS/DNR directive is the property of the declarant and shall be kept with the declarant's medical record, but is not part of the medical record.

(a) To be honored by EMS personnel, the EMS/DNR directive must be placed in an unobstructed view above the declarant on the wall or in close proximity to the head of the bed or the declarant must be wearing the EMS/DNR bracelet, except in health care facilities licensed pursuant to Title 26, Chapter 21.

(b) To be honored by EMS personnel who are called to render service in health care facilities licensed pursuant to Title 26, Chapter 21, the EMS/DNR directive must be displayed in the declarant's medical record or the declarant must be wearing an EMS/DNR bracelet. Health care facility personnel must present the medical record to responding EMS personnel upon their arrival. Health care facilities shall document for Department review that appropriate health care facility staff have been informed of the declarant's EMS/DNR directive sufficient to notify EMS personnel of the existence of the EMS/DNR directive.

(5) If the EMS/DNR directive is not complete or does not appear to conform to statutory and regulatory requirements, the Department shall notify the physician and explain the defect or defects and shall notify the declarant or proxy and EMS agencies likely to respond to the declarant.

 

R426-100-4. Revocation of an EMS/DNR Directive.

(1) An EMS/DNR bracelet is the embodiment of an EMS/DNR directive and shall be given the same legal treatment as the actual EMS/DNR directive. An EMS/DNR directive may be revoked as provided in Section 75-2-1111.

(2) If both the original of the EMS/DNR directive with the watermark and the EMS/DNR bracelet are not intact, or have been defaced, the EMS/DNR directive is invalid. If an EMS/DNR directive is revoked, EMS personnel must provide emergency medical services to the declarant as if no EMS/DNR directive had been issued.

(3) If there is any question about the validity of an EMS/DNR directive, the EMS personnel must provide emergency medical services to the declarant as if no EMS/DNR directive had been issued.

 

R426-100-5. Treatment of a Declarant with an EMS/DNR Directive.

(1) As part of routine patient assessment, EMS personnel must inspect to see if the declarant is wearing an EMS/DNR bracelet or has an EMS/DNR directive either clearly displayed or located within the declarant's medical record file. If the EMS/DNR directive appears to be incorrectly executed, incomplete, or otherwise flawed in the making, EMS personnel need not honor the EMS/DNR directive. EMS personnel are not liable for failure to honor an EMS/DNR directive.

(2) An EMS/DNR directive only directs that life sustaining procedures be withheld. It does not direct the withholding of medication or the performance of any medical procedure either of which is intended to provide comfort care or to alleviate pain.

(3) In the case of a declarant who has sustained a recent injury clearly unrelated to the terminal condition that served as the basis for the EMS/DNR directive, EMS personnel may contact medical control regarding the provision of emergency medical services to the declarant.

 

R426-100-6. Transferable Physician Order for Life Sustaining Treatment.

(1) EMS personnel shall honor a patient's desires for life-sustaining treatment as expressed through the treating physician's written orders. EMS personnel shall comply with treating physician orders for life-sustaining treatment as expressed on Transferable Physician Order for Life-sustaining Treatment Forms, including a physician order not to resuscitate a patient that does not meet the formalities on the EMS/DNR form established in this rule. A patient shall always be provided respect, comfort, and hygienic care.

(2) A health care facility may present a completed Transferable Physician Order for Life-sustaining Treatment Form in lieu of an EMS/DNR directive or bracelet.]

(1) This rule is adopted pursuant to Utah Code Title 26, Chapter 21, and Section 75-2a-110.

(2) This rule establishes the forms and systems for Life with Dignity Orders.

 

R426-100-2. Definitions.

In addition to the definitions found in 75-2a, "Health care facility" is as defined in Section 26-21-2.

 

R426-100-3. Life with Dignity Order-Forms.

An individual who desires to execute a Life with Dignity Order must use the form created by the Department. The form may not be altered in layout or style, including font style and size, without the express written permission of the Department.

 

R426-100-4. Life with Dignity Order Creation-Facility Responsibilities.

(1) Upon admission to a health care facility described in Subsection (2), the health care facility shall:

(a) make a good faith effort to determine whether the individual has completed a Life with Dignity Order;

(b) inform each individual (or if the individual does not have the capacity to act, the individual's family or legal representative) about the Life with Dignity Order in the same manner as required for providing information about advance directives; and

(c) offer each individual an opportunity to complete a Life with Dignity Order.

(2) Health care facilities that must comply with Subsection (1):

(a) a general acute hospital licensed under R432-100;

(b) a long-term acute care facility licensed under R432-104;

(c) a critical access hospital licensed under R432-106;

(d) a nursing care facility licensed under R432-150;

(e) a mental retardation facility licensed under R432-152;

(f) a small health care facility (four to sixteen beds) licensed under r432-200;

(g) an assisted living facility licensed under r432-270;

(h) a small health care facility - type N licensed under r432-300;

(i) a home health agency licensed under R432-700; and

(j) a hospice agency licensed under R432-700.

 

R426-100-5. Transferability and Availability of Life with Dignity Orders.

(1) A Life with Dignity Order is fully transferable between all health care facilities.

(a) If a health care facility transfers an individual with a Life with Dignity Order to another health care facility, the sending health care facility shall provide a copy of the Life with Dignity Order to the receiving health care facility.

(b) The receiving health care facility and health care providers at the receiving health care facility shall read the Life with Dignity Order.

(2) A health care facility shall allow a patient or resident to complete or amend a Life with Dignity Order at any time upon request.

(3) The health care facility shall place the Life with Dignity Order in a prominent part of the individual's current medical record.

(4)(a) Except for home health agencies and home-based hospice, health care facility personnel must present the medical record, including the Life with Dignity Order, to EMS personnel upon their arrival.

(b) If an individual at a health care facility possesses a Life with Dignity Order, the health care facility, except for home health agencies and home-based hospice, must inform responding EMS personnel of the Life with Dignity Order.

(5)(a) If an individual under the care of a home health agency or a hospice agency possesses a Life with Dignity Order, the agency must ensure that a copy of the Life with Dignity Order is left at the individual's place of residence.

(b) For an individual who resides at home, it is recommended that the Life with Dignity Order be posted on the front of the refrigerator or over the individual's bed.

 

R426-100-6. Review of Life with Dignity Orders.

A health care facility caring for an individual with a Life with Dignity Order shall ensure that appropriate personnel as provided in Section 75-2a-106(2) review the Life with Dignity Order with the individual (or if the individual does not have the capacity to act, the individual's family or legal representative) if:

(1) there is a substantial, permanent change in the individual's health status; or

(2) the individual's treatment preferences change.

 

R426-100-7. Life with Dignity Bracelets and Necklaces.

(1) An individual with a Life with Dignity Order may obtain an approved Life with Dignity bracelet or necklace from a vendor approved by the Department. The approved Life with Dignity bracelet or necklace identifies the individual to EMS or other health care providers as possessing a Life with Dignity Order.

(2) The bracelet or necklace shall clearly display "Utah EMS Life with Dignity Order" and the individual's name.

(3) The bracelet or necklace is available in two colors:

(a) Purple indicates that the EMS or other health care personnel should not attempt or continue resuscitation.

(b) Yellow indicates that the EMS or other health care personnel should attempt to resuscitate the individual.

(4) EMS or other health care personnel who encounter an individual with a Life with Dignity bracelet or necklace shall attempt to find the Life with Dignity Order to determine the details of the individual's health care preferences.

(a) If EMS or other health care personnel are unable to locate the Life with Dignity Order, the color of the necklace or bracelet indicates the legal presence of a valid Life with Dignity Order with instructions consistent with the color coding as provided in Subsection (3).

(b) Regardless of the type of Utah EMS Life with Dignity Order worn by the individual, EMS or other health care personnel may provide measures to alleviate pain and discomfort for the individual.

 

R426-100-8. Validity of Prior Orders.

EMS and other health care providers may recognize as valid all prior advance directives, POLST orders, and EMS/DNR orders, including bracelets and necklaces, unless superceded by a subsequent advance directive or Life with Dignity Order.

 

KEY: [emergency medical services]POLST, do not resuscitate, Life with Dignity Order

Date of Enactment or Last Substantive Amendment: [September 6, 2006]2009

Notice of Continuation: October 1, 2004

Authorizing, and Implemented or Interpreted Law: 75-2-1105.5

 

 

ADDITIONAL INFORMATION

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For questions regarding the content or application of this rule, please contact Guy Dansie at the above address, by phone at 801-538-9171, by FAX at 801-538-6808, or by Internet E-mail at gdansie@utah.gov

For questions about the rulemaking process, please contact the Division of Administrative Rules (801-538-3764). Please Note: The Division of Administrative Rules is NOT able to answer questions about the content or application of these administrative rules.

Last modified:  12/30/2008 12:22 PM