TITLE 77: PUBLIC HEALTH
CHAPTER I: DEPARTMENT OF PUBLIC HEALTH
SUBCHAPTER f: EMERGENCY SERVICES AND HIGHWAY SAFETY
PART 515 EMERGENCY MEDICAL SERVICES, TRAUMA CENTER, COMPREHENSIVE STROKE CENTER, PRIMARY STROKE CENTER AND ACUTE STROKE READY HOSPITAL CODE
SECTION 515.380 DO NOT RESUSCITATE (DNR) POLICY


 

Section 515.380  Do Not Resuscitate (DNR) Policy

 

a)         A System shall adopt a Regional standardized DNR policy for use by System personnel.  The policy shall be implemented only after it has been reviewed and approved by the Department, in accordance with the requirements of this Section.  For purposes of this Section, DNR refers to the withholding of cardiopulmonary resuscitation (CPR) and cardiocerebral resuscitation (CCR); electrical therapy to include pacing, cardioversion and defibrillation; invasive airway management and manually or mechanically assisted ventilations, unless otherwise stated on the DNR Advance Directive.

 

b)         The policy shall include, but not be limited to, specific procedures and protocols for cardiac arrest/DNR situations arising in long-term care facilities, with hospice and home care patients, and with patients who arrest during inter-hospital transfers or transportation to or from home.

 

c)         The policy shall include specific procedures and protocols for withholding CPR and CCR in situations where explicit signs of biological death are present (e.g., decapitation, rigor mortis without profound hypothermia, profound dependent lividity), or the patient has been declared dead by a coroner/medical examiner or the patient's physician.  The policy shall include recording such information on the patient care report.

 

d)         For situations not covered by subsection (c) of this Section, the policy shall require that resuscitative procedures be followed unless a valid DNR Advance Directive is present.

 

e)         The Department of Public Health Uniform DNR Advance Directive or a copy of that Advance Directive shall be honored.  (Section 3.57 of the Act)  If the Department Uniform DNR Advance Directive is reproduced, it is recommended that brightly colored paper be used.  Systems shall also have a policy in place concerning recognition of other DNR Advance Directives.  The information required on the Department Uniform DNR Advance Directive includes, but is not limited to, the following items:

 

1)         Name of the patient,

 

2)         Name and signature of attending physician,

 

3)         Effective date,

 

4)         The words "Do Not Resuscitate",

 

5)         Evidence of consent:

 

A)        signature of patient; or

 

B)        signature of legal guardian; or

 

C)        signature of durable power of attorney for health care agent; or

 

D)        signature of surrogate decision-maker.

 

f)         A living will by itself cannot be recognized by pre-hospital care providers.

 

g)         Revocation of a written DNR Advance Directive shall be made only in one or more of the following ways:

 

1)         The Advance Directive is physically destroyed by the physician who signed the Advance Directive or by the person who gave written consent to the Advance Directive; or

 

2)         The Advance Directive is verbally rescinded by the physician who signed the Advance Directive or by the person who gave written consent to the Advance Directive and the word "VOID" is written in large letters across the front of the Advance Directive, and the Advance Directive is signed and dated by the physician who signed the Advance Directive or by the person who gave written consent to the Advance Directive.

 

h)         A System's DNR policy shall require System personnel to make a reasonable attempt to verify the identity of the patient (for example, identification by another person or an identifying bracelet) named in a valid DNR Advance Directive.

 

i)          The policy shall describe the roles of the on-line medical control physician and ECRN in DNR situations.

 

j)          The policy shall state which System EMS personnel are authorized to respond to a valid DNR Advance Directive (EMT-P, EMT-I, EMT-B, Pre-hospital RN, First Responder (FR), First Responder/Automated External Defibrillator (FR/AED)).

 

k)         The policy shall cross-reference the System's coroner/medical examiner notification policy.

 

l)          The policy shall describe the System's program for educating System personnel concerning the policy.

 

m)        The policy shall identify the quality assurance measures specific to this policy, including the methods and periods of review.

 

(Source:  Amended at 32 Ill. Reg. 16255, effective September 18, 2008)