Page 65 - 2020 ARE eGuide for Clinical at Nonhospital Sites
P. 65
Levels of End-of Life Care - A Review of the Guidelines
A discussion must be held with Level 1: Cardiac Resuscitation
the capacitated patient who Respiratory arrest with pulse may intubate
acknowledges agreement with Full Medical Management
the levels of end-of-life care. Code Rescue Allowed / Code Blue for Intubation Only
After an incapacitated patient's Level II: No Cardiac Resuscitation; No Intubation
Full Medical Management
physician has made the
Code Rescue Allowed / NO Code Blue
determination and appropriately
documented that the patient has a Level III: No Cardiac Resuscitation; No Intubation, and
terminal condition, end stage no Extraordinary Measures as checked below:
condition, or is in a persistent Do not transfer to higher level of care
Do not titrate vasopressors
vegetative state, a discussion is held
Do not initiate new vasopressors
with the legal decision maker
No dialysis
(healthcare surrogate, proxy, or
Do not transfuse
guardian). Do not re-intubate
No surgery
If the legal decision maker is in
Other:______(free text)
agreement with the levels of end-
of-life care (EOL) recommendations Code Rescue Allowed / No Code Blue
and what is believed to be the
Level IV: No Cardiac Resuscitation, No Intubation,
patient's wishes under these Comfort Measures Only (CMO):
circumstances or in the patient's Allow natural death.
best interest if no prior indication Patient receives care and treatment necessary to relieve pain,
was made by the patient, he/she will maintain comfort and preserve dignity (refer to CMO DO).
sign the Authorization by the Deactivation of Implantable Cardiac Rhythm Device (ICD) is
Legal Decision Maker to Withhold requested, refer to Deactivation of Cardiac Rhythm Device
Order
Life Prolonging Procedures for
Life-prolonging therapies are being withdrawn, the
Incapacitated Patients form for
Determination of Patients Condition must be signed by 2
the initial (EOL) orders.
physicians, and Authorization for Withdrawal must be signed by
For any subsequent EOL orders, the patient’s legal decision maker for incapacitated patients.
the physician discusses with the If additional symptom management needed, call provider STAT
legal decision maker and obtains No Code Blue
and documents their verbal Levels of End of Life are orders rescinded. Patient is a
consents in the medical record. full code.
