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Why is POLST needed?POLST was developed to improve the quality of patient care by creating a system that identifies patients’ wishes regarding medical treatment and communicates and respects them by creating portable medical orders. While POLST supports the completion of advance directives, clinical experience and research demonstrate that these advance directives are not sufficient alone to assure that those who suffer from serious illnesses or frailty will have their preferences for treatment honored unless a POLST form is also completed. Research shows that by recording people’s wishes based on their present condition and updating those orders as the condition or wishes change, a POLST form is not only effective in capturing individual preferences, but does so more accurately than traditional advance directives for individuals with serious illness or frailty. Individuals with POLST orders reflecting a preference for comfort measures were also less likely to receive life-sustaining medical intervention than individuals with POLST full-treatment orders – reflecting the fact that POLST orders result in greater adherence by medical personnel. A survey of hospices in three states found that POLST forms were useful in preventing unwanted medical care and at initiating conversations about treatment preferences. The survey also found that health care professionals respected treatment limitations specified in POLST forms 98% of the time and that no patients received unwanted CPR. A prospective study of nursing home residents with POLST orders for DNR and Comfort Measures Only found that none received unwanted CPR, ICU care, or ventilator support. A POLST form can also help ensure people receive desired treatment. For example, a 2014 study of forms in the Oregon POLST registry found that 33.1% of forms contained orders for limited or full treatment. The earlier three-state survey of hospices found that 78% of patients specified something more than comfort measures. |
Descriptions of POLSTShort Form (66 words): National POLST improves the quality of care for patients who are seriously ill or frail by creating a voluntary system that elicits, documents and honors patient medical treatment wishes through portable medical orders. A POLST form is completed based on conversations between patients and health care professionals about goals of care, quality of life, diagnosis, prognosis and treatment options. Long Form (192 words): National POLST improves the quality of care for patients who are seriously ill or frail by creating a system that elicits, documents and honors patient medical treatment wishes through portable medical orders. POLST is part of advance care planning, a process that includes conversations between patients and health care professionals about goals of care and quality of life. Everyone is encouraged to complete an advance directive but recognize its limitation: advance directives are not medical orders so emergency personnel cannot follow guidance provided in an advance directive during a medical emergency. Instead, once the patient is in the hospital and stabilized, the health care team works with the surrogate identified in the advance directive and reviews the patient’s wishes to develop a treatment plan. With a POLST form, the treatment plan is developed in advance and moved upstream; the medical orders on the form give clear instructions to emergency personnel about whether the patient wanted CPR and whether they wanted to go to the hospital or remain where they are. POLST is always voluntary and should be available to all seriously ill or frail individuals. |
POLST Philosophical Policy
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Who is the POLST form intended for?A POLST form is not for everyone. The POLST decision-making process and resulting medical orders are intended for patients who are considered to be at risk for a life-threatening clinical event because they have a serious life-limiting medical condition, which may include advanced frailty. For these patients, their current health status indicates the need for standing medical orders. For healthy patients, an advance directive is an appropriate tool for making future end-of-life care wishes known to loved ones. |
About National POLST
Two-page overview of National POLST