Caregiver Revolution

In the hospital where I work, as I’m going about my daily physical therapy business I have recently noticed the appearance of colorful pink forms in many of the charts. I feel that this kind of snuck up on me, ie I should have investigated and posted about these forms eons ago!

In any case, over the next few months we are going to be hearing a lot more about “Physician’s Order for Life Sustaining Treatment” forms. These turn “individuals’ treatment wishes into actionable medical orders that can be taken from one care setting to another.”  The Catholic Church doesn’t like them and officials won’t say that POLSTS have any thing to do with advanced directives, but the POLST form has more official weight with emergency personnel than an advance directive so it is probably a good thing to check out. Here is a POLST fact sheet taken from Washington Dept of Health.

What is POLST?

POLST is a form and the term stands for “Physician’s Order for Life Sustaining Treatment.” The POLST form was developed for use by Emergency Medical personnel and replaces forms previously used by them. It contains information about an individual’s end of life decisions such as cardiopulmonary resuscitation (CPR). It also contains information about the individual’s choices for medical treatment issues such as tube feedings and the use of antibiotics.

 Is POLST an advance directive?

No. According to the Department of Health the form itself is not an advance directive.

 What does the POLST form do?

The most frequent use of the form is as a summary of an individual’s advance directive decisions and information. The form turns that information into a physician’s order that is signed by both the physician and the individual. You may want to talk with residents who have made advance directive decisions about the POLST form so that they can decide whether or not they want to complete and sign one and have their physician do so also.

It may also be that the POLST form can be used to record an informed consent decision about end of life issues by a person legally authorized to make health care decisions in place of the resident. The legal decision maker would sign and the physician.

 Is there other information on the POLST form that could be useful in deciding what to do for a resident?

Yes. The POLST form also contains areas where the resident can indicate other choices about future medical events, such as medical treatment for comfort, limited medical treatment or full treatment. There are also areas where the resident can indicate preferences for using antibiotics, and tube feedings.

 Should there be a completed POLST form without an advance directive?

While advance directives are often very helpful in determining end-of-life decisions, they are not required for having a POLST form. A POLST form may accompany a resident being admitted and the admitting facility/home can use it for guidance regarding an individual’s end of life choices until additional advance directive information is obtained.

If the form is used to record informed consent decisions made by the legal decision maker at the time of the event, it may not be accompanied by the resident’s advance directive information.

Can there be an advance directive without a POLST form?

Yes. It may be beneficial to have both but it is the individual’s choice.

 Why is a POLST form important?

Emergency medical services (EMS) personnel work under the authority and guidance of a physician. In order for them to be able to honor an individual’s request related to end of life decisions, the EMS must have a physician’s order. The POLST form provides both the summary of the individual’s advance directive decisions, and the physician’s order.

 Are there any other ways the POLST form can be used?

Yes. First, the form can be used by an admitting facility/home to provide information about a resident’s advance directive choices before the facility/home has a chance to get more specific information through the assessment process.

Second, the original form should go with the resident when they are discharged or transferred to another health care setting in order to provide the new facility/home with initial information about the resident’s choices and to be available to emergency personnel when needed.

 Should advance directives and any POLST form be accessible?

Yes. Both should be kept in a place easily accessible by anyone who has the right to or need for that information and Washington State Medical Association recommends the POLST form being the first document in the resident’s record. If they are kept in the same place for everyone in the facility then staff or anyone else who has the right to the information will know, or be able to tell someone, where to quickly access the information.

 Do I need to have policies and procedures related to the use of the POLST form?

Yes. You will need to have policies and procedures related to advance directives. The policies and procedures should also include what staff can do with and about a POLST form

 Should I implement an individual’s POLST form in an emergency?

Unless you are a licensed medical or nursing professional you may likely not have the scope of practice to evaluate the situation or to implement the individual’s advance directive. In that case you must call 911.

 Are there any other issues that should be considered related to POLST form use?

We understand that there are issues related to legal immunity for anyone other than emergency medical personnel following the directions in the POLST. Please contact your legal professional for any related legal questions.