Administrative Procedure 5162.1 - Maryland Medical Orders for Life Sustaining Treatment (MOLST) (formally known as Do Not Resuscitate Orders)

I. Purpose

To provide procedures for school system response to a Maryland Medical Orders for Life-Sustaining Treatment (MOLST) form.

II. Policy

The Board of Education directs schools to accept and follow Maryland Medical Orders for Life Sustaining Treatment (MOLST) if the Order is signed by the student’s treating physician, nurse practitioner (NP) or physician’s assistant (PA). (Board Policy 5162.1)

III. Definitions

1. DNR (Do Not Resuscitate) – the withholding of cardiopulmonary resuscitation (CPR), artificial ventilation, and other related life-sustaining procedures in the event of cardiac or respiratory arrest. A DNR order is separate from other aspects of the student’s care. Unless otherwise specified, there should be no implied or actual abandonment of other supportive care such as administration of oxygen, suctioning, use of the Heimlich maneuver, control of bleeding and pain, and positioning for comfort.
2. Emancipated child – a student who has not yet attained 18 years of age but is married, in the military, or the court has declared that they are emancipated and fiscally independent from their parent or guardian. A child who is a parent (under the age of 18) is only emancipated as it relates to the infant/child.
3. Maryland Medical Orders for Life Sustaining Treatment (MOLST) – A form that includes medical orders for Emergency Medical Services (EMS) and other medical personnel regarding cardiopulmonary resuscitation and other life sustaining treatment options for a specific student. The form must be completed accurately and legibly, signed and dated by the physician, nurse practitioner (NP), or physician assistant (PA).
4. Minor child – a student who has not yet attained 18 years of age or a student 18 years of age who is cognitively impaired and unable to make medical decisions.
5. Parent(s) – the parent(s) or guardian(s), who have custody of a minor child and the power to make medical decisions for that minor child.

IV. Procedures

1. Signatures Required. A MOLST form must be signed by a student’s treating physician, nurse practitioner (NP) or physician assistant (PA). The form must be accurately and legibly completed, signed, and dated.

2. Receipt of MOLST Order. Upon receiving the MOLST Order, the school principal or designee shall forward a copy to the Supervisor of School Health for review.

3. School’s Response to Receiving the MOLST Order. The Supervisor of School Health in conjunction with the Nurse Manager and Professional School Nurse will develop an Individualized Health Care Plan for the child consistent with the MOLST Order. The Office of School Health will notify, the principal and schedule a meeting with the child’s parent(s) or guardian(s), the Supervisor of School Health or designee, the Professional School Nurse, the student’s teacher(s) and other staff, as appropriate to discuss the plan of care. At the meeting:

   1. An opportunity will be provided to resolve any questions that the school’s staff may have regarding the operation of the MOLST Order.

   2. The principal will inform the child’s parent(s)/guardians(s) that should their child have a possible incident leading to implementation of the MOLST Order, the school personnel will contact them and call 911. The principal will also inform the parent(s)/guardian(s) of the need to notify the local Prince George’s County Fire Department about the child’s special needs and the MOLST Order.

4. Location of MOLST Order. The original or a copy of the official order shall be readily available and accompany the student at all times so it can be retrieved and given to Emergency Medical Services (EMS) providers and other health care providers at the receiving hospital. A copy will also be kept in the health record, Office of School Health and in the Limited Access Folder (LAF) CUM.

5. Training of Staff. The Office of School Health Supervisor or designee shall provide training and counseling for the school staff and transportation staff as soon as possible after receiving the signed MOLST order.

   1. The School Health Supervisor or designee and principal shall provide an opportunity for the staff to meet to discuss the implementation of the MOLST order. The MOLST Individual Student Plan will be completed by the Professional School Nurse reflecting the options completed on the signed and dated form. Trained staff names and titles will be recorded on this form. This training will be done annually and as needed with new school system personnel.

   2. The child’s parent(s)/guardian(s) will be invited to attend this meeting, but are not required to attend.

6. Life-threatening Emergency at School. Should the child experience cardiac or respiratory arrest, school personnel shall call the parent(s)/guardian(s) and 911.

   1. School System employees will provide appropriate aid and comfort to the child limited by the MOLST Order while awaiting the arrival of Emergency Medical Services providers.

   2. The Professional School Nurse will remain with the student until the arrival of Emergency Medical Service.

   3. A copy of the MOLST order must accompany the student.

7. Need for Crisis-Intervention Team. Should the situation result in the student’s death, the school’s Crisis Team will respond to the needs of students, staff, and the community.

8. Rescinding MOLST Order. Any parent or guardian who has custody of the student or emancipated student may rescind the MOLST Order at any time. The physician, NP, or PA must write VOID in large letters on the form and sign and date the form. A registered nurse can take a verbal order from a MD, NP, or PA to void the MOLST form. The voided order will be kept in the medical record and LAF. In an emergency situation a competent emancipated student can request resuscitation directly to EMS providers.

9. Annual Review. MOLST orders shall be reviewed by the Supervisor of School Health or designee annually. There is no expiration date for MOLST or EMS DNR orders in Maryland. If the student’s medical condition changes, the Supervisor of School Health or designee may contact the parent and then the physician, NP or PA and request a review of the order. Only a physician, NP, or PA may update or void an existing order.

10. Student Transfers. The principal of the school from which a student with the MOLST order transfers will inform the principal of the new school of the student’s condition and MOLST order. The principal at the new school will follow the steps required in the procedures set forth in (C) through (H) of this Administrative Procedure. The same procedure shall also be followed for summer school students who have a MOLST Order.

V. Monitoring and Compliance

MOLST Forms shall be reviewed by the Supervisor of School Health or designee annually.

VI. Related Procedures

• Administrative Procedure 2950 - Procedures for Crisis Response

VII. Legal Reference

COMAR 10.01.21. and COMAR 13A.05.05.08-09.

VIII. Maintenance and Update of These Procedures

The Supervisor of School Health will have the responsibility of maintaining, evaluating, and updating this procedure. The Department of Student Services will maintain and update this procedure as necessary.

IX. Cancellations and Supersedures

This procedure cancels and supersedes Administrative Procedure 5162.1, dated August 24, 1995.

X. Effective Date

August 26, 2019

About This Procedure

Last Revised: August 26, 2019

Documents

• Administrative Procedure 5162.1 - Maryland Medical Orders for Life Sustaining Treatment (MOLST) (formally known as Do Not Resuscitate Orders).pdf
• Procedimiento Administrativo 5162.1 - Órdenes médicas de tratamiento de soporte vital (MOLST).pdf