Iowa Healthcare Collaborative

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Iowa Physician Orders for Scope of Treatment (IPOST)

The Iowa Physician Orders for Scope of Treatment, known as IPOST, is a double-sided, one-page document, salmon in color 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.

IPOST Mission
:  To promote community care coordination and advance care planning.

IPOST Vision:
Seamless communication and execution of individual patient care choices across the healthcare continuum. 
 


 
IPOST Form

Target Audience: Who should utilize an IPOST form?
      1.    The chronically, seriously ill individual frequently visiting healthcare facilities.
      2.    An individual with a life-limiting illness.
      3.    Frail and elderly individuals.

Download IPOST Form - From IDPH
If you plan to print your own IPOST forms, make sure you have the most up-to-date version.  Recommended paper is Boise Fireworx Multi-Use Paper, Jammin' Salmon color, 20/50 weight.

IPOST Section Information
Providers and healthcare facilities can use this document to review each section of the IPOST form. 

IPOST Order Form
Order a bundle of 100 pre-printed IPOST forms from IHA. 

NOTE:  If you plan to keep a supply of forms on hand, whether self-printed or ordered, please regularly review the form to ensure that you are using the most up-to-date version of the form. 
 



Policies and Procedures

Iowa Code, Chapter 144D is the Iowa legislative law pertaining to the IPOST form.
      1. The IPOST form is a standardized form that is easily recognizable.
      2. The form will be placed in the front of the patient’s medical chart, when admitted.
      3. The form belongs to the patient and will transfer with the patient from one healthcare setting to another.
      4. The IPOST form can be voided or updated if the patient’s treatment preferences change.
 

 The form must have:

  1. Name and date of birth of patient
  2. Patient or durable power of attorney or surrogate signature and date when form completed,
  3. Provider signature and date when form completed.
  4. Patient treatment preferences for medical care documented in the following sections:
               4.1.    CPR or DNR
               4.2.    The amount of medical interventions in medical emergency
               4.3.    Nutrition by G-tube
               4.4.    Medical Care Decisions (rationale).
  5. Incomplete section on the form shall imply the patient's wishes for full treatment for the type of treatment identifed in the incomplete section.
     

NOTE: Advance directive and living wills will not be replaced by the IPOST form.  IPOST form supports health decisions stated in living will or advance directive by making health decisions medical orders.
 


 
Educational Materials

IPOST Process sheets:
Acute Care Facilities
Emergency Department
Emergency Medical Services
Providers
Nursing Facilities
Nursing Facility Protocol

A Way to Make Your Own Choices About Your End of Life Medical Care
Providers and healthcare facilities can use this brochure to review IPOST form process and procedures.  This brochure can also be used to provider patient education about the IPOST form.

IHC and IDPH Presentation: IPOST in Iowa - November 2013
Providers and facilities can use this presentation by Gerd Clabaugh and Kady Hodges to review current IPOST Law information, work plan, and IPOST structure.

IHC IPOST Informational Webcast
This is an informational IPOST presentation by Tom Evans, M.D. and Shannon Strickler from July 2012.

Iowa Hospital Association IPOST Webcast
This IPOST webcast presentation, by Dr. Bell to the Iowa Hospital Association, is from November 2012.  Providers can use this webcast to review IPOST section information.

Iowa Physician Orders for Scope of Treatment (IPOST): Out of Hospital DNR Orders for Terminally Ill Children
Providers and healthcare facilities can use this PowerPoint presentation by A. Paige Volk, MD to view patient stories and guidelines to use the IPOST form.

IPOST Fact Sheet
Providers and healthcare facilities can use this fact sheet, from the University of Iowa Children's Hospital, to review frequently asked questions and facts about the IPOST form.
 



Additional Resources

Advanced Illness: Feeding Tubes and Ventilators
This website, created by the Family Caregiver Alliance, provides information on the use of artificial nutrition and ventilators.

Artificial Nutrition and Hydration: Beneficial or Harmful
This page was created by the American Hospice Foundation to assist family and healthcare providers with understanding the benefits of artificial nutrition.

The Conversation Project
This website contains resources for patients and families to initiate the conversation surrounding end-of-life care preferences. 

End of Life Issues
This page was produced by the American College of Emergency Physicians to assist in end-of-life communication between family and healthcare providers.

End of Life Issues - Online Resources for Caregivers
This website contains information on end of life treatment options and intervention options.

Go Wish Game
This is an online interactive game where cards are selected at random and rated. An individual will rate them, from most important to least important, for end-of-life treatment decisions.



IPOST Pilot Resources

IPOST Guidebook
This is the guideline book used by hospitals during the pilot implementation period.

IPOST Process Training
This training was developed for facility employees during the pilot implementation period.
 


 
IPOST News

End-of-life Care: An Oregon Innovation Helps People Avoid Unwanted Interventions
This article from The Oregonian the POLST program implementation in Oregon.

Medical IPOST Form Gaining Acceptance Statewide
This article and video from KCRG explains IPOST acceptance in Cedar Rapids, Iowa.

New Efforts to Simplify End-of-life Care Wishes
This article from the Wall Street Journal discusses the POLST program across the United States.

New Form Aims to Clarify End-of-life Wishes
This IHA article explains IPOST implementation and acceptance across the state of Iowa.



National Programs

POLST Oregon Program
California POLST Program
Colorado MOST Program
LaCrosse Wisconsin POLST Program
Louisiana LaPOST Program
Montana POLST Program
New York MOLST Program
North Carolina MOST Program
Pennsylvania POLST Program
Tennessee POST Program
Utah POLST Program
Washington POLST Program
West Virginia POST Program


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**For additional information or questions about this toolkit, contact Kady Hodges.


Toolkit Created: April 7, 2013
Updated: March 11, 2014