DAR File No. 28500

Health, Health Systems Improvement, Licensing

R432-31

Transferable Physician Order for Life-Sustaining Treatment

NOTICE OF PROPOSED RULE

DAR File No.: 28500
Filed: 02/08/2006, 01:22
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

This rulemaking updates the rule regarding the Physician Order for Life Sustaining Treatment (POLST). Since the rule went into effect in 2002, health providers have had a chance to use the form and review the rules associated with it. The updates will clarify the process for using a POLST form and add details that are provided in a training packet that was used with the form, but were not included in the rule.

Summary of the rule or change:

The rule changes will add the steps a health facility will take to ensure that all patients have been given an opportunity to use the form. Another change will add "nurse practitioner" as someone who can sign the form, instead of just a physician. This has been allowed by practice, but not clarified in the rule. The rule also adds details regarding patient preferences and who can make changes to the form or void it altogether.

State statutory or constitutional authorization for this rule:

Title 26, Chapter 21

Anticipated cost or savings to:

the state budget:

This rule amendment does not increase any requirements or work load to the Department or other agencies. It only clarifies existing requirements in the POLST rule. There is no anticipated aggregate cost to the state budget.

local governments:

This rule amendment does not increase any requirements or work load to the local governments. It only clarifies existing requirements in the POLST rule. There is no anticipated cost to local governments.

other persons:

This rule amendment does not increase any requirements to other persons. It only clarifies existing requirements in the POLST rule. There is no anticipated cost to local governments.

Compliance costs for affected persons:

The rule amendments clarify existing requirements for providers using the POLST form. There are no anticipated compliance costs for providers or individuals using the forms.

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

This rule change will strengthen the ability to direct an individual's own health care through a Physician's Order. This form has been very useful to practitioner's in Utah. David L. 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:

Direct questions regarding this rule to:

Joel Hoffman at the above address, by phone at 801-538-6165, by FAX at 801-538-6163, or by Internet E-mail at jhoffman@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:

03/31/2006

This rule may become effective on:

04/01/2006

Authorized by:

David N. Sundwall, Executive Director

RULE TEXT

R432. Health, Health Systems Improvement, Licensing.

R432-31. Transferable Physician Order for Life-Sustaining Treatment.

R432-31-1. Legal Authority.

This rule is adopted pursuant to Title 26, Chapter 21.

R432-31-2. Purpose.

This rule provides for the orderly communication and transfer of physician orders that outline [patient]individual preferences for life-sustaining treatment when an [patient]individual transfers from one licensed health care facility to another.

R432-31-3. Definitions.

"Advance directive" means a written instruction, such as a living will or durable power of attorney for health care, recognized under State law relating to the provision of health care when an individual is incapacitated.

R432-31-[3]4. Transferable Physician Order.

(1) A physician may enter a [patient's]individual's preferences and the physician's orders for life- sustaining treatment on a transferable physician order form. The Department shall, in consultation with the Health Facility Committee, design a uniform transferable physician order for life-sustaining treatment form that may be used by physicians and health care facilities.

(2) Upon admission to a health care facility or acceptance to a home health agency, the facility or agency shall make a good faith effort to determine whether the individual's physician has completed a transferable physician order for life-sustaining treatment.

(a) Health care facilities shall inform each individual, or if the individual does not have the capacity to act, the individual's family or legal representative, about transferable physician orders for life-sustaining treatment in the same manner as required for providing information about advance directives.

(b) The facility shall offer each individual an opportunity to complete a transferable physician order for life-sustaining treatment upon admission to the facility.

(c) The facility shall place the transferable physician order for life-sustaining treatment in a prominent part of the individual's current medical record.

(3) A physician or licensed practitioner, as defined in R432-1-3(69), must sign the transferable physician order for life sustaining treatment.

[(3)](4) A health care facility or its employee that makes a good faith effort to follow the instructions in a transferable physician order for life-sustaining treatment is not subject to any Department sanction as a result of those good faith efforts.

(5) The facility shall review the transferable physician order for life-sustaining treatment with the individual, or if the individual does not have the capacity to act, the individual's family or legal representative, when any of the following occur:

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

(b) the individual is transferred from one care setting to another; and

(c) the individual's treatment preferences change.

[(4)](6) The transferable physician order for life-sustaining treatment is fully transferable between all licensed health care facilities.

[(5)](7) A transferring licensed health care facility shall send the physician order for life-sustaining treatment, if it exists, with the [patient]individual to the receiving facility. The receiving facility and health care providers at the receiving facility shall honor the physician order for life-sustaining treatment until it has been properly changed or voided.

KEY: health facilities

Date of Enactment or Last Substantive Amendment: [December 19, 2002]2006

Authorizing, and Implemented or Interpreted Law: 26-21

ADDITIONAL INFORMATION

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For questions regarding the content or application of this rule, please contact Joel Hoffman at the above address, by phone at 801-538-6165, by FAX at 801-538-6163, or by Internet E-mail at jhoffman@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.