216 R.I. Code R. 216-RICR-20-15-4.4

Current through December 26, 2024

Section 216-RICR-20-15-4.4 - Medical Orders for Life Sustaining Treatment

4.4.1Treatment of Qualified Patients.

A qualified patient has the right to make decisions regarding use of life sustaining procedures as long as the patient is able to do so. If a qualified patient is not able to make those decisions, the declaration governs decisions regarding use of life sustaining procedures.

4.4.2Medical Orders for Life Sustaining Treatment.

A. The MOLST is a voluntary option for qualified patients. No patient is required to elect a MOLST.

B. A declaration by a qualified patient may be recorded as a medical order for life-sustaining treatment provided that:

1. The medical orders for life-sustaining treatment and medical intervention and procedures are explained by a MOLST qualified health care provider to the qualified patient or recognized health care decision maker. The MOLST qualified health care provider shall further inform the qualified patient of the difference between an advance health care directive and MOLST medical order;

2. A MOLST qualified health care provider has conducted an evaluation of the qualified patient; and

3. A MOLST form documenting the declaration has been completed by a MOLST qualified health care provider based on qualified patient preferences and medical appropriateness, and has been signed by a MOLST qualified health care provider and the qualified patient or his or her recognized health care decision maker.

C. A MOLST qualified health care provider may conduct an evaluation of the qualified patient and, if necessary, in consultation with the qualified patient or recognized health care decision maker, issue a MOLST consistent with the most current information available about the qualified patient's health status and care preferences.

D. A MOLST form shall be completed or updated by a MOLST qualified health care provider in accordance with instructions provided by the Department. Except as otherwise provided by the Act or these Regulations, a MOLST qualified health care provider shall complete or update a MOLST form in a manner that is consistent with:

1. The known decisions of:

a. A competent qualified patient; or

b. A recognized health care decision maker.

2. Any known advance directive if the qualified patient is incapable of making an informed decision.

E. A health care provider shall treat a qualified patient in accordance with the qualified patient's MOLST, subject to the provisions of the Act and these Regulations.

F. A request regarding resuscitative measures may also be evidenced by the words "do not resuscitate" or the letters "DNR," in a qualified patient's medical record and/or through a mechanism established by the Department consistent with the provisions of the Act and these Regulations.

G. A recognized health care decision maker may execute the MOLST form if the qualified patient lacks capacity, or if the qualified patient has designated that the health care decision maker's authority is valid.

4.4.3MOLST Form

A. A MOLST shall be documented on an easily identifiable form approved by the Director.

B. The MOLST form approved by the Director is the only MOLST form that may be completed and signed within the State of Rhode Island.

C. The MOLST form shall contain all other information as required by these Regulations.

D. The MOLST form shall be signed by the qualified patient, or the qualified patient's recognized health care decision maker, and a MOLST qualified health care provider.

4.4.4Validity of MOLST Form.

A. A MOLST form shall apply regardless of whether the qualified patient executes the MOLST form within or outside a hospital or other health care setting.

B. The MOLST form is valid within or outside a hospital or other health care setting.

4.4.5Revocation of a MOLST Form.

A. A qualified patient or his/her recognized health care decision maker may, at any time, revoke in any manner that communicates an intent to revoke his/her declaration by informing the MOLST qualified health care providers, other health care providers, or any member of the medical or nursing staff of the revocation of the declaration concerning life-sustaining or resuscitative measures.

B. Any member of the medical or nursing staff informed of a revocation shall immediately notify a MOLST qualified health care provider of the revocation.

C. The MOLST qualified health care provider informed of a revocation of MOLST made pursuant to these Regulations shall immediately:

1. Record the revocation in the qualified patient's medical record;

2. Cancel any orders implementing the decision to withhold or withdraw treatment; and

3. Notify the health care providers and staff directly responsible for the qualified patient's care of the revocation and any cancellations.

D. If a decision to withhold or withdraw life-sustaining treatment has been made by a recognized health care decision maker pursuant to the Act or these Regulations, and the MOLST qualified health care provider determines at any time that the decision is no longer appropriate or authorized because the qualified patient has regained decision-making capacity or because the qualified patient's condition has otherwise improved, the MOLST qualified health care provider shall immediately:

1. Include such determination in the qualified patient's medical record;

2. Cancel any orders or plans of care implementing the decision to withhold or withdraw life-sustaining treatment;

3. Notify the recognized health care decision maker who made the decision to withhold or withdraw treatment; and

4. Notify the other health care providers, including the medical and nursing staff directly responsible for the qualified patient's care, of any cancelled MOLST orders or plans of care.

E. A MOLST form shall only be voided by a MOLST qualified health care provider.

F. To void a MOLST form, draw a diagonal line through the sheet, write "VOID" in large letters across the page, and sign and date below the line.

4.4.6Resolving Conflicts Between MOLST Forms.

If the medical records of a qualified patient contain more than one MOLST form, the orders contained in the most recent MOLST form shall be followed unless and until the form is updated.

4.4.7Reproduction and Alteration of the MOLST Form.

A. A health care provider may freely copy, store electronically, and subsequently print or otherwise reproduce a MOLST form provided by the Department.

B. A MOLST qualified health care provider may not alter the contents or format of a MOLST form provided by the Department.

4.4.8Voiding a MOLST Form.

A. A MOLST qualified health care provider can give a verbal order to void the MOLST form if there is documentation that there was discussion with the qualified patient or the patient's recognized health care decision maker about discontinuing the MOLST order. A nurse can then take the verbal order to VOID the MOLST form. Documentation of the MOLST discussion will be placed in the patient's record when the verbal order is verified.

B. The voided MOLST form shall be kept in the patient's active or archived medical record.

216 R.I. Code R. 216-RICR-20-15-4.4