Medical IPOST Form Gaining Acceptance Statewide

By Dave Franzman, Reporter

CEDAR RAPIDS, Iowa - A simple form that conveys the medical treatment wishes of someone with a terminal or serious medical condition became a law in Iowa a year ago. But supporters say making sure all medical providers statewide understand the IPOST document and how to use it is something that's still a work in progress.

IPOST stands for Iowa Physician Orders for Scope of Treatment. The distinctive salmon-colored one page form is Iowa's version of a medical orders document also used in a number of states. But while it's been the law for more than a year, supporters are still teaching the nurses, doctors and emergency responders who may come in contact with the document exactly what it means and how to use it to talk to both patients and family members about their medical wishes in trying circumstances.

Christine Harlander, a Palliative Care Nurse at Mercy Medical Center, was part of the group that pioneered the idea in first Linn and then Jones County. That pilot project led to the bill signed by the governor in 2012 making the form legally recognized statewide. Since IPOST began in eastern Iowa in 2008, about two thousand patients have listed their medical wishes on the document. IPOST travels with the patients from hospital to nursing home or hospice and is often the first document listed in individual medical records.

And Harder said it's not just something for those diagnosed as terminally ill alone.

"This is also designed for the frail and elderly. I may be 90 with five or ten more years to live. But if my heart and breathing stopped would I want a natural death and not have CPR (cardio-pulmonary resuscitation)," Harlander said.

Harlander said the IPOST form does not replace a Do-Not-Resuscitate (DNR) order, living willing or advanced medical directive or similar documents that some patients use to make their medical wishes known in the face of a "what-if" scenario . It's something medical professionals will present to a patient or family only if circumstances warrant.

Kim Lesting and her mother Virginia Peterson had never heard of an IPOST form until last Friday. Peterson, of Oelwein, had serious medical complications recently and just underwent surgery. There is a question of whether she'll be able to return to her home. Harlander visited both mother and daughter last week to have a "goal of care" discussion and explain the IPOST form.

Kim Lesting said while her mother had filled out medical directive paperwork in the past, the new form was easy, specific and gave both peace of mind and a feeling difficult medical questions in the future have already been answered.

"It's already stated, marked off and they (medical providers) can refer to it—I can refer to it and we can move ahead with what she wants," Lesting said.

Peterson added that it was good to put her thoughts on paper and the document will speak for her later if she's unable to speak for herself.

"Very comforting, not only for myself but for the kids," Peterson said.

IPOST offers simple "check boxes" asking if a patient wishes CPR performed in case of no pulse or breathing has stopped. It also inquires if a patient wishes only comfort care or full treatment such as a transfer to an intensive care unit (ICU) in the event of a life-threatening incident.

Harlander said medical providers in about half the state have now been trained in how to present the IPOST form to patients and families. She expects the process of familiarizing all medical providers in the state should wrap up within the next year.
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