What is POLST P hysician O rders for L ife S ustaining T reatment Why POLST Patient wishes often are not known The Advance Health Care Directive AHCD may not be accessible Wishes may not be clearly defined in AHCD ID: 769189
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What is POLST? P hysician O rders for L ife S ustaining T reatment
Why POLST? Patient wishes often are not known. The Advance Health Care Directive (AHCD) may not be accessible. Wishes may not be clearly defined in AHCD. The AHCD is not a physician order. Allows healthcare providers to know and honor wishes during serious illness.
Patient Story: What We Know
Patient Story: What We Didn’t Know ©California Medical Association 2017
Patient Story: What Happened AHCD not transferred with patient DNR wishes not documented Over-treatment against patient wishes Unnecessary pain and suffering
What is POLST? A medical order recognized throughout the medical system Portable document that transfers with the patientBrightly colored, standardized form for entire state of California
What is POLST? Allows individuals to choose medical treatments they want to receive, and identify those they do not want Provides direction for healthcare providers during serious illness
Who Would Benefit from Having a POLST Form? Chronic, progressive illness Serious health condition Medically frail Tool for determination “You wouldn’t be surprised if this patient died within the next year”
POLST History POLST development began in Oregon in 1991 Expanded to more than half of the United States
Developing Programs (24) National POLST Paradigm Programs Endorsed Programs (22) No Program/Contacts (1) *As of June 2018 Mature Programs (2) www.polst.org Programs That Do Not Conform to POLST Requirements (4)
POLST Success Oregon Study: Location of Death and POLST Orders 58,000 deaths reviewed, 31% had POLST in Oregon Registry Patient treatment choices honored, including avoiding dying in hospital Fromme EK, JAGS 2014
POLST in California The Coalition for Compassionate Care of California (CCCC) is lead agency Support from California Health Care Foundation Grassroots efforts of local POLST coalitions and communities
POLST in California Assembly Bill 3000 Original POLST legislation Effective January 1, 2009 Assembly Bill 637 Authorizes NPs and PAs to sign POLST Effective January 1, 2016
POLST in California One form for entire state Use not mandated Honoring form is mandatedProvides immunity from civil or criminal liability AB 3000, Wolk. Part 4, Sec 7, Probate Code Section 4782
POLST vs. Advance Health Care Directive POLST complements the Advance Health Care Directive (AHCD )POLST is not intended to replace the AHCDBoth are legal documents AB 3000, Part 4, Sec 3, Probate Code 4780 (3) (c)
POLST vs. Advance Health Care Directive POLST AHCD For seriously ill/frail, at any age Medical orders for medical treatment Can be signed by decision-maker For anyone 18 and older General instructions for treatment Appoints decision-maker
Where Does POLST Fit In? Advance Care Planning Continuum Complete an Advance Directive Complete a POLST Form Age 18 Treatment Wishes Honored Diagnosed with Serious or Chronic, Progressive Illness (at any age) Update Advance Directive Periodically C O N V E R S A T I O N S
POLST vs. Pre-Hospital DNR(Do Not Resuscitate) Similarities: Medical orders Address Do Not Resuscitate Intended for medically frail or those with chronic or serious illness
POLST vs. Pre-Hospital DNR(Do Not Resuscitate) POLST Pre-Hospital DNR Allows for choosing resuscitation Allows for other medical treatments Honored across all healthcare settings Can only use if choosing DNR Only applies to resuscitation Only honored outside the hospital
POLST vs. PIC(Preferred Intensity of Care) POLST PIC Consistent form for California Is a medical order Honored across all healthcare settings PIC form is different in every SNF Is not a medical order; similar to a doctor’s note Only used within the SNF
POLST vs. PIC(Preferred Intensity of Care) Both include choices for medical interventions. POLST can replace the PIC form at SNF. POLST is a voluntary form.
CA POLST Form – Front Side
Section A: CPR
Section B: Medical Interventions
Diagram of POLST Medical Interventions CPR Comfort-Focused Treatment DNR Full Treatment* Selective Treatment *Consider time/prognosis factors under “Full Treatment” “Trial Period of Full Treatment” may be checked if prolonged life support is not desired.
Section C: Artificially Administered Nutrition
The POLST Conversation POLST is not just a check-box form. The POLST Conversation provides context for patients/families to:Make informed choices.Identify goals of treatment.
Section D: Information and Signatures
Who Can Speak for the Patient? Surrogate decision-maker/agent Parent, registered domestic partner, guardian, conservator Closest available relative
CA POLST Form – Back Side
Who Can Help Complete POLST? Healthcare providers – “licensed, certified, or otherwise authorized to provide health care in the normal course of business” Best practice suggests use of those trained in the POLST Conversation: PhysiciansNurses, Nurse Practitioners, Physician Assistants Social Workers Chaplains Social Service Designees
Directions – Completing POLST
Directions – Using POLST
Directions – Reviewing/Modifying/Voiding POLST
When Should POLST be Reviewed? Transfer from one care setting to another Change in patient’s health condition Patient’s treatment preferences changePatient Care Conference Best Practice : Update POLST forms to the most current version when reviewing older POLST forms.
Can POLST be Changed? Patient with capacity can request alternative treatment or revoke a POLST at anytime. Legally recognized decision-maker may request a change based on condition change or new information regarding patient wishes.
Where Should We Keep POLST? Original pink POLST stays with patient At SNF/Hospital: File in medical chart (with AHCD ) Send original with patient upon return to home/SNF/hospitalKeep copy if patient transferred; review POLST upon patient’s return
Where Should We Keep POLST? At home: Post in easy-to-find location (with AHCD ) Give to EMS to transport with patient
POLST: Depth of the Process POLST is more than a form. POLST: Facilitates rich conversations with patients/families. Complements the AHCD. Incorporates the importance of comfort.
California POLST Project The Coalition for Compassionate Care of California (CCCC) provides leadership and oversight for POLST outreach activities in California, with support from the California Health Care Foundation. C oalition for C ompassionate C are of C alifornia
POLST C onversation A rich conversation with each individual patient C omprehensive Education To promote excellent conversational skills with patients and families C onsistent Form Standardized form recognized across care settings Translating an individual’s wishes for care during serious or chronic illness into medical orders that honor those preferences for medical treatment. C ommunity Collaboration Integrating POLST into the community standard of care California POLST Project
California POLST Form Available at www.caPOLST.org Translations available May be purchased from: www.med-pass.com (bulk forms/paper) www.cmanet.org (POLST Kit)
California POLST Form Print on Ultra Pink, 65# card stock paper Copies/faxes on any color paper are acceptable Focus on the conversation
POLST Resources Consumer Brochure FAQs
POLST Resources Model policies and procedures Standardized educational curriculum Local POLST coalitions www.caPOLST.org
Questions?