2018 Kentucky Revised Statutes CHAPTER 311 - PHYSICIANS, OSTEOPATHS, PODIATRISTS, AND RELATED MEDICAL PRACTITIONERS .6225 Medical order for scope of treatment (MOST) form -- Eligible persons -- Scope -- Effect.
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311.6225 Medical order for scope of treatment (MOST) form -- Eligible persons -Scope -- Effect.
(1)
An adult with decisional capacity, an adult's legal surrogate, or a responsible party
may complete a medical order for scope of treatment directing medical
interventions. The form shall have the title "MOST, Medical Orders for Scope of
Treatment" and an introductory section containing the patient's name and date of
birth, the effective date of the form, including the statement "Form must be
reviewed at least annually" and the statements "HIPAA permits disclosure of
MOST to other health care professionals as necessary" and "This document is based
on this person's medical condition and wishes. Any section not completed indicates
a preference for full treatment for that section." The form shall be in substantially
the following order and format and shall have the following contents:
(a) Section A of the form shall direct cardiopulmonary resuscitation when a
person has no pulse and is not breathing by selection of one (1) of the
following:
1.
"Attempt Resuscitation (CPR)"; or
2.
"Do Not Attempt Resuscitation"; and
include the statement "When not in cardiopulmonary arrest, follow orders in
B, C, and D.";
(b) Section B of the form shall direct the scope of treatment when a person has a
pulse or is breathing by selection of one (1) of the following:
1.
Full scope of treatment, including the use of intubation, advanced airway
interventions, mechanical ventilation, defibrillation or cardioversion as
indicated, medical treatment, intravenous fluids, and comfort measures.
This option shall include the statement "Transfer to a hospital if
indicated. Includes intensive care. Treatment Plan: Full treatment,
including life support measures.";
2.
Limited additional intervention, including the use of medical treatment,
oral and intravenous medications, intravenous fluids, cardiac monitoring
as indicated, noninvasive bi-level positive airway pressure, a bag valve
mask, and comfort measures. This option excludes the use of intubation
or mechanical ventilation. This option shall include the statement
"Transfer to a hospital if indicated. Avoid intensive care. Treatment
Plan: Provide basic medical treatments."; or
3.
Comfort measures, including keeping the patient clean, warm, and dry;
use of medication by any route; positioning, wound care, and other
measures to relieve pain and suffering; and the use of oxygen, suction,
and manual treatment of airway obstruction as needed for comfort. This
option shall include the statement "Do not transfer to a hospital unless
comfort needs cannot be met in the patient's current location (e.g. hip
fracture).".
These options shall be followed by a space for other instructions;
(c) Section C of the form shall direct the use of oral and intravenous antibiotics
(d)
(e)
by selection of one (1) of the following:
1.
Antibiotics if indicated for the purpose of maintaining life;
2.
Determine use or limitation of antibiotics when infection occurs;
3.
Use of antibiotics to relieve pain and discomfort; or
4.
No antibiotics, use other measures to relieve symptoms.
This option shall include a space for other instructions;
Section D of the form shall:
1.
Have the heading "Medically Administered Fluids and Nutrition: The
provision of nutrition and fluids, even if medically administered, is a
basic human right and authorization to deny or withdraw shall be limited
to the patient, the surrogate in accordance with KRS 311.629, or the
responsible party in accordance with KRS 311.631.";
2.
Direct the administration of fluids if physically possible as determined
by the patient's physician in accordance with reasonable medical
judgment and in consultation with the patient, surrogate, or responsible
party by selecting one (1) of the following:
a.
Long-term intravenous fluids if indicated;
b.
Intravenous fluids for a defined trial period. This option shall be
followed by "Goal:................."; or
c.
No intravenous fluids, provide other measures to ensure comfort;
and
3.
Direct the administration of nutrition if physically possible as
determined by the patient's physician in accordance with reasonable
medical judgment and in consultation with the patient, surrogate, or
responsible party by selecting one (1) of the following:
a.
Long-term feeding tube if indicated;
b.
Feeding tube for a defined trial period. This option shall be
followed by "Goal:................."; or
c.
No feeding tube. This option shall be followed by a space for
special instructions;
Section E of the form shall:
1.
Have the heading "Patient Preferences as a Basis for this MOST Form"
and shall include the language "Basis for order must be documented in
medical record";
2.
Provide direction to indicate whether or not the patient has an advance
medical directive such as a health care power of attorney or living will
and, if so, a place for the printed name, position, and signature of the
individual certifying that the MOST is in accordance with the advance
directive; and
3.
Indicate whether oral or written directions were given and, if so, by
which one (1) or more of the following:
a.
b.
c.
d.
(f)
(g)
Patient;
Parent or guardian if patient is a minor;
Surrogate appointed by the patient's advance directive;
The judicially appointed guardian of the patient, if the guardian has
been appointed and if medical decisions are within the scope of the
guardianship;
e.
The attorney-in-fact named in a durable power of attorney, if the
durable power of attorney specifically includes authority for health
care decisions;
f.
The spouse of the patient;
g.
An adult child of the patient or, if the patient has more than one (1)
child, the majority of the adult children who are reasonably
available for consultation;
h.
The parents of the patient; and
i.
The nearest living relative of the patient or, if more than one (1)
relative of the same relation is reasonably available for
consultation, a majority of the nearest living relatives;
A signature portion of the form shall include spaces for the printed name,
signature, and date of signing for:
1.
The patient's physician;
2.
The patient, parent of minor, guardian, health care agent, surrogate,
spouse, or other responsible party, with a description of the relationship
to the patient and contact information, unless based solely on advance
directive; and
3.
The health care professional preparing the form, with contact
information;
A section of the form shall be titled "Information for patient, surrogate, or
responsible party named on this form" with the following language: "The
MOST form is always voluntary and is usually for persons with advanced
illness. MOST records your wishes for medical treatment in your current state
of health. The provision of nutrition and fluids, even if medically
administered, is a basic human right and authorization to deny or withdraw
shall be limited to the patient, the surrogate in accordance with KRS 311.629,
or the responsible party in accordance with KRS 311.631. Once initial
medical treatment is begun and the risks and benefits of further therapy are
clear, your treatment wishes may change. Your medical care and this form can
be changed to reflect your new wishes at any time. However, no form can
address all the medical treatment decisions that may need to be made. An
advance directive, such as the Kentucky Health Care Power of Attorney, is
recommended for all capable adults, regardless of their health status. An
advance directive allows you to document in detail your future health care
instructions or name a surrogate to speak for you if you are unable to speak for
yourself, or both. If there are conflicting directions between an enforceable
(h)
(i)
living will and a MOST form, the provisions of the living will shall prevail.";
A section of the form shall be titled "Directions for Completing and
Implementing Form" with these four (4) subdivisions:
1.
The first subdivision shall be titled "Completing MOST" and shall have
the following language:
"MOST must be reviewed, prepared, and signed by the patient's
physician in personal communication with the patient, the patient's
surrogate, or responsible party.
MOST must be reviewed and contain the original signature of the
patient's physician to be valid. Be sure to document the basis in the
progress notes of the medical record. Mode of communication (e.g., in
person, by telephone, etc.) should also be documented.
The signature of the patient, surrogate, or a responsible party is required;
however, if the patient's surrogate or a responsible party is not
reasonably available to sign the original form, a copy of the completed
form with the signature of the patient's surrogate or a responsible party
must be signed by the patient's physician and placed in the medical
record.
Use of original form is required. Be sure to send the original form with
the patient.
There is no requirement that a patient have a MOST.";
2.
The second subdivision shall be titled "Implementing MOST" and shall
have the following language: "If a health care provider or facility cannot
comply with the orders due to policy or personal ethics, the provider or
facility must arrange for transfer of the patient to another provider or
facility.";
3.
The third subdivision shall be titled "Reviewing MOST" and shall have
the following language:
"This MOST must be reviewed at least annually or earlier if:
The patient is admitted and/or discharged from a health care facility;
There is a substantial change in the patient's health status; or
The patient's treatment preferences change.
If MOST is revised or becomes invalid, draw a line through Sections AE and write "VOID" in large letters."; and
4.
The fourth subdivision shall be titled "Revocation of MOST" and shall
have the following language: "This MOST may be revoked by the
patient, the surrogate, or the responsible party."; and
A section of the form shall be titled "Review of MOST" and shall have the
following columns and a number of rows as determined by the Kentucky
Board of Medical Licensure:
1.
"Review Date";
2.
3.
4.
5.
(2)
(3)
"Reviewer and Location of Review";
"MD/DO Signature (Required)";
"Signature of Patient, Surrogate, or Responsible Party (Required)"; and
"Outcome of Review, describing the outcome in each row by selecting
one (1) of the following:
a.
No Change;
b.
FORM VOIDED, new form completed; or
c.
FORM VOIDED, no new form".
The Kentucky Board of Medical Licensure shall promulgate administrative
regulations in accordance with KRS Chapter 13A to develop the format for a
standardized medical order for scope of treatment form to be approved by the board,
including spacing, size, borders, fill and location of boxes, type of fonts used and
their size, and placement of boxes on the front or back of the form so as to fit on a
single sheet. The board may not alter the wording or order of wording provided in
subsection (1) of this section, except to add identifying data such as form number
and date of promulgation or revision and instructions for completing, reviewing,
and revoking the election of the form. The board shall consult with appropriate
professional organizations to develop the format for the medical order for scope of
treatment form, including:
(a) The Kentucky Association of Hospice and Palliative Care;
(b) The Kentucky Board of Emergency Medical Services;
(c) The Kentucky Hospital Association;
(d) The Kentucky Association of Health Care Facilities;
(e) LeadingAge Kentucky;
(f) The Kentucky Right to Life Association; and
(g) Other groups interested in end-of-life care.
The medical order for scope of treatment form developed under subsection (2) of
this section shall include but not be limited to:
(a) An advisory that completing the medical order for scope of treatment form is
voluntary and not required for treatment;
(b) Identification of the person who discussed and agreed to the options for
medical intervention that are selected;
(c) All necessary information necessary to comply with subsection (1) of this
section;
(d) The effective date of the form;
(e) The expiration or review date of the form, which shall be no more than one (1)
calendar year from the effective date of the form;
(f) Indication of whether the patient has a living will directive or health care
power of attorney, a copy of which shall be attached to the form if available;
(g) An advisory that the medical order for scope of treatment may be revoked by
the patient, the surrogate, or a responsible party at any time; and
(h)
(4)
(5)
A statement written in boldface type directly above the signature line for the
patient that states "You are not required to sign this form to receive
treatment."
A physician shall document the medical basis for completing a medical order for
scope of treatment in the patient's medical record.
The patient, the surrogate, or a responsible party shall sign the medical order for
scope of treatment form; however, if it is not practicable for the patient's surrogate
or a responsible party to sign the original form, the surrogate or a responsible party
shall sign a copy of the completed form and return it to the health care provider
completing the form. The copy of the form with the signature of the surrogate or a
responsible party, whether in electronic or paper form, shall be signed by the
physician and shall be placed in the patient's medical record. When the signature of
the surrogate or a responsible party is on a separate copy of the form, the original
form shall indicate in the appropriate signature field that the signature is attached.
Effective: June 24, 2015
History: Created 2015 Ky. Acts ch. 3, sec. 2, effective June 24, 2015.
Legislative Research Commission Note (6/24/2015). During codification, the Reviser of
Statutes has changed the numbering of subparagraphs within paragraphs (d) and (e)
of subsection (1) of this statute from the way it appeared in 2015 Ky. Acts ch. 3, sec.
2.
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