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Another tool

In end of life issues, IPOST gives patients a voice in their care

March 28, 2013
By PETER KASPARI, pkaspari@messengernews.net , Messenger News

A document that allows people with serious medical conditions to control their medical care has debuted in Webster County.

The Iowa Physician Orders for Scope of Treatment is filled out by patients and informs doctors of the level of medical intervention they want in cases when they are unable to speak for themselves.

IPOST was introduced into Webster County on Feb. 15.

Article Photos

-Messenger photo by Peter Kaspari
the rev. Phil Somsen, chaplain and coordinator of pastoral care at Trinity Regional Medical Center, goes over an Iowa Physician Orders for Scope of Treatment — or IPOST — form at the hospital.

The Rev. Phil Somsen, chaplain and coordinator of pastoral care at Trinity Regional Medical Center, who serves as the county's lead IPOST facilitator, said IPOST is a result of laws that allow patients to refuse life-sustaining medical treatment if they wish.

"It allows people to ask what represents the fullness of a person and what makes my life worth living," Somsen said. "You and I want to live as much as we can as long as there's a purpose."

While there are other forms, such as living wills, that help people communicate what they want done to them, IPOST is used exclusively for emergencies.

The IPOST form is filled out with the help of a facilitator, who is available to answer questions about the document.

"After it's filled out, it's signed by a medical professional, which can be a physician, a physician's assistant or a nurse practitioner," Somsen said. "It becomes a medical order that staff honor. It's like having your provider right at your bedside."

The forms are generally used for elderly patients or people who are suffering from terminal medical conditions such as cancer or Lou Gehrig's Disease, according to Somsen.

IPOST addresses CPR done without a heartbeat or pulse, feeding procedures and how much care should be given.

People who have an IPOST are asked to keep it in a plastic sleeve on their refrigerator.

"We've done training with the local fire departments, emergency room and EMTs," Somsen said. "They are trained to ask where the IPOST is when they get called out to an emergency. Someone will also ask what kind of medications the patient is on or if they have advanced directives."

The IPOST always travels with the patient, according to Somsen.

He added that there are more than 30 facilitators in Webster County who have been trained in IPOST.

Kevin Doty, assistant Fort Dodge police chief, said dispatchers in the Webster County Law Enforcement Center can tell if a patient has an IPOST if they've filled out another specific form.

"We have these 911 mailers that are available to the community," Doty said. "You fill out your name, phone number and address, as well as medical conditions."

Other information on the 911 mailers includes details such as the presence of watch dogs, whether the person is bedridden or on oxygen, and the location of their hospital.

The forms also list medication the patient is taking and if they've had prior medical conditions such as a heart attack or stroke.

Doty said the mailers were recently updated to include whether or not the caller has an IPOST. All this information is put into the law enforcement dispatchers' computers and comes up as soon as a call comes in.

"The only catch is this card is tied to your landline," Doty said. "When you call 911 from a landline, that number is tied to the people at your residence."

Cell phones, unfortunately, can complicate the system because the person calling isn't necessarily at their home.

Still, there are benefits and Somsen said it's better to discuss getting an IPOST sooner than later.

"By having these conversations early on, the patients and families can make an informed decision," Somsen said. "Too often these procedures aren't addressed until the situation becomes critical."

If an IPOST isn't filled out and the patient becomes unable to speak for themselves, Somsen said it's the family's responsibility to decide on the extent of care.

"The law says the spouse becomes the automatic agent, followed by the adult children," he said.

Once the decision falls to the adult children, Somsen said it can become complicated. If there are two children, both have to agree on the treatment. If there are more than two, a majority of the children need to make the decision on treatment.

"It can start to get real crazy over what one wants to do," Somsen said. "With advanced directives, you can appoint someone to be at the top of that list."

IPOST allows patients to specifically say what they want done to them if they aren't able to speak for themselves.

"Everybody should be able to receive the care that they want," Somsen said. "But they also have the option to not receive care if they choose. IPOST provides the opportunity for people to have that in-depth conversation."

Information on the IPOST can also be changed if the patient decides they would rather go with another option.

Somsen said he believes IPOST will provide help to people who are in failing health.

"If they want to continue their care, they're free to do that," he said, "but IPOST has the potential to put a stop to that revolving door by asking them, is this what you want?"

 
 

 

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