What is IPOST?
The Iowa Physician Orders for Scope of Treatment, known as IPOST, is a double-sided, one-page document that allows a person to communicate their preferences for key life-sustaining treatments including: resuscitation, general scope of treatment, artificial nutrition and more. IPOST is appropriate for an individual who is frail elderly, or who has a chronic, critical medical condition or terminal illness.
In the last stages of illness, health decisions can be complicated and difficult for the patient, their families, and even the treating health providers. IPOST helps health providers guide and support the patient and their families during this sensitive time. A completed IPOST creates a clear declaration of the patient’s healthcare treatment choices and assures that the patient’s wishes are fulfilled at the prescribed time.
Iowa Code 144D: Physician Orders for Scope of Treatment (IPOST)
IPOST Strategic Overview
IPOST Mission and Vision
Mission: To promote community care coordination and advanced care planning
Vision: Seamless communication and execution of individual patient care choices across the healthcare continuum
History
The IPOST pilot project began in Cedar Rapids in late 2008 as a result of legislative language included in House File 2165. In 2010, the project was extended with a rural pilot authorized in Jones County.
The model created an Iowa version of the national POLST (Physician Orders for Life Sustaining Treatment) movement. The local IPOST projects were legislatively required to report to a statewide advisory council charged with making recommendations to the State Legislature. The State Advisory Council had 16 members representing various areas within the health care field.
On July 1, 2012, Iowa Code Chapter 144D - Physician Orders for Scope of Treatment - was signed into law.
Form and Guidance
The Iowa Department of Public Health was responsible for prescribing how the uniform IPOST form looks. The double-sided, one-page document allows a person to communicate their preferences for key life-sustaining treatments including: resuscitation, general scope of treatment, artificial nutrition, and more.
According to the statute, the IPOST form shall be a uniform form and shall have all of the following characteristics:
- Patient’s name and date of birth.
- Signed and dated by the patient or patient’s legal representative.
- Signed and dated by the patient’s physician, advanced registered nurse practitioner, or physician assistant.
- Signed and dated by the facilitator if the preparation of the form was done by an individual other than the patient’s physician, advanced registered nurse practitioner, or physician assistant.
The form shall include the patient’s wishes regarding the care of the patient, including but not limited to all of the following:
- The administration of cardio pulmonary resuscitation (i.e. - what happens in circumstances where the patient has no pulse and is not breathing).
- The level of medical interventions in the event of a medical emergency (i.e. - comfort measures only, limited interventions, or full treatment).
- The use of medically administered nutrition by tube (i.e. - artificially administer nutrients for patients who cannot take oral nutrition or hydration by mouth).
- The rational for the orders.