Posted On Dec 17

A POLST is a Physician’s Order for Life Sustaining Treatment.  Take a look at this 11-minute podcast about Advance Care Planning from the New England Journal of Medicine blog.

New England Journal of Medicine podcast. Clinical Conversations.

POLSTs.

  • They are physicians’ orders written at a time when the healthcare staff would not be surprised if the patient died within the next 12 months.
  • Others may answer the POLST questions on behalf of the patient, if the patient is unable to express his or her own wishes.
  • The question asked is simple. “What were the patient’s wishes about end of life care?”

See Erik K. Fromme, MD et al, “POLST Registry Do-Not-Resuscitate Orders and Other Patient Treatment Preferences,” JAMA, 2012:307(1).

How is that different from a Patient Advocate Designation?

  • In a Patient Advocate Designation, only an adult patient of sound mind can answer the questions and provide the instructions.
  • A patient advocate designation is not limited to patients who are at the end of life.
  • Most patients cannot give specific instructions about care they may need fifty years from now. Therefore, in a patient advocate designation, the patient names a person who will make medical decisions for them when the patient is no longer able to make those decisions.
  • A patient advocate designation provides immunity for healthcare providers for honoring the patient advocate’s authority.
  • A patient advocate designation is recognized by the court as a document to be used to provide clear and convincing evidence of the patient’s wishes.

Compare a Patient Advocate Designation to a POLST.

  • A patient advocate designation is appropriate for patients who are 18 or older and of sound mind. It applies to a much wider range of adults than a POLST does.
  • A patient advocate designation does not make advance decisions on paper and put those decisions, with a signed consent, in the patient’s medical chart. A POLST requires advance decisions to be made and an order to be put in the chart – the nurses follow the order and there is no need to call family first for a decision to be made. A patient advocate designation, on the other hand, requires contact to be made with the patient advocate any time a decision must be made that requires someone with legal authority to sign a consent form for the patient.

What might be in a POLST form?

Section A – CPR (No pulse AND is not breathing)

___Attempt Resuscitation/ CPR

___ Do not attempt CPR/ No Resuscitation

Section B – Medical Interventions (has pulse and/or is breathing) All patients will receive comfort measures.

___Advanced interventions: Use intubation, advanced invasive airway interventions, mechanical ventilation, cardioversion and other advance interventions as medically indicated.

___Limited interventions: DO NOT use intubation, advanced invasive airway interventions, or mechanical ventilation. Use medical treatment, IV fluids and cardiac monitor as indicated. Transfer to hospital if indicated. Avoid intensive care.

___Comfort measures only. Use medication by any route, positioning, wound care and other measures to relieve pain and suffering. Use oxygen, suction, manual treatment of airway obstruction and non-invasive respiratory assistance as needed for comfort. Only transfer to hospital if comfort needs cannot be met in current situation.

Section C – Artificially Administered Nutrition Artificially administered nutrition: Always offer food by mouth if feasible.

___ Long-term artificial nutrition

___Defined trial period of artificial nutrition

___No artificial nutrition

 

This form should be reviewed periodically if:

1. The patient/resident is transferred from one care setting or care level to another;

2. There is a substantial change in patient/resident health status such as:

• Improved condition

• Permanent unconsciousness

• Advanced progressive illness

• Close to death

• Extraordinary suffering

• The patient’s/resident’s treatment decisions change.

If this form is revoked, write “VOID” on both sides in large letters, then sign and initial the form. After voiding the form, a new form may be completed. If no new form is completed, full treatment and resuscitation shall be provided.

SEND ORIGINAL FORM WITH PERSON WHENEVER TRANSFERRED OR DISCHARGED