25 Tex. Admin. Code § 157.25 - Out-of-Hospital Do Not Resuscitate (OOH-DNR) Order
(a) Purpose. The purpose of this section
shall be to establish a statewide OOH-DNR protocol as required in the Health
and Safety Code, Title 2, Chapter 166.
(b) Out-of-Hospital DNR order. An OOH-DNR
order may be issued by an attending physician for any patient. That attending
physician has responsibility for ensuring that the form is filled out in its
entirety and that the information regarding the existence of an OOH-DNR order
is entered into the patient's medical record.
(c) Protocol development. An OOH-DNR protocol
in accordance with this section, shall apply to all out-of-hospital settings
including cardiac arrests which occur during interfacility transport. The
protocol shall include the following:
(1) a
copy of the Department of State Health Services (department) standardized
OOH-DNR order form listing the designated treatments that shall be withdrawn or
withheld. Those treatments shall be:
(A)
cardiopulmonary resuscitation;
(B)
advanced airway management;
(C)
artificial ventilation;
(D)
defibrillation; and
(E)
transcutaneous cardiac pacing.
(2) an explanation of the patient
identification process to include an option to use a department-standardized
identification device such as a necklace or bracelet; and
(3) an on-site OOH-DNR dispute resolution
process which includes contacting an appropriate physician.
(d) Recordkeeping. Records shall
be maintained on each incident in which an OOH-DNR order or OOH-DNR
identification device is encountered by responding healthcare professionals,
and the number of cases where there is an on-site revocation of the DNR order
shall be recorded.
(1) The data documented
should include:
(A) an assessment of
patient's physical condition;
(B)
whether an identification device or an OOH-DNR form was used to confirm DNR
status and patient identification number;
(C) any problems relating to the
implementation of the OOH-DNR order;
(D) the name of the patient's attending
physician; and
(E) the full name,
address, telephone number, and relationship to patient of any witness used to
identify the patient.
(2) These records must be maintained and
shall meet records retention requirements for each health care
profession.
(3) If the patient is
transported, the original OOH-DNR order or a copy of the original order will be
kept with the patient.
(4) Copies
of the original OOH-DNR order may be put on file with concerned parties, and
the original order shall remain in the possession of the patient, a legal
guardian, or the healthcare facility responsible for the patient's
care.
(e) Out-of-state
OOH-DNR Orders. Personnel may accept an OOH-DNR order or device that has been
executed in any other state, if there is no reason to question the authenticity
of the order or device.
(f) Failure
to honor an OOH-DNR order. If there are any indications of unnatural or
suspicious circumstances, the provider shall begin resuscitation efforts until
such time as a physician directs otherwise.
(g) Pregnant persons. A person may not
withhold the designated treatments listed in subsection (c)(1) from a person
known by responding healthcare professionals to be pregnant.
(h) Out-of-Hospital DNR Form. The executive
commissioner or the commissioner's appointees shall furnish the department's
OOH-DNR order forms to physicians, clinics, hospitals, nursing homes, hospices
and home health agencies throughout the state upon request.
(1) The form shall contain all the
information as prescribed in the Health and Safety Code, Chapter 166.
(2) The form shall be 8-1/2 inches by 11
inches, printed front and back, and in the format specified by the department
as follows.
(i) Out-of-Hospital DNR Identification
devices. As an optional means of identification, a patient may obtain, at
patient's expense, an OOH-DNR device. An OOH-DNR device, as approved by the
Department of State Health Services, must meet the following requirements:
(1) An intact, unaltered, easily identifiable
plastic identification OOH-DNR bracelet, with the word "Texas" (or a
representation of the geographical shape of Texas and the word "STOP" imposed
over the shape) and the words "Do Not Resuscitate," shall be honored by
qualified EMS personnel in lieu of an original OOH-DNR order form.
(2) An intact, unaltered, easily identifiable
metal bracelet or necklace inscribed with the words, "Texas Do Not Resuscitate
- OOH" shall be honored by qualified EMS personnel in lieu of an OOH-DNR order
form.
(3) The person or entity who
provides an OOH-DNR identification device to an individual shall send with the
identification device a statement with the words, "Pursuant to Health and
Safety Code, §
166.090,
this identification device may only be worn by a person who has executed a
valid out-of-hospital DNR order."
Notes
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