Considerations for Development or Revision of a POLST Form
A major responsibility of a developing POLST Program is to design a form that includes a medical order set. Also, an established program must revise their form periodically to respond to advances in technology, considerations for special patient groups, and improved methods of communicating the orders. The NPPTF has developed the following general and specific requirements to help guide programs in this responsibility.
- The treatment being considered requires a medical order that is signed by a health care professional.
- The medical order is based on medical indication and a person’s preferences for treatment (e.g. as expressed in an Advance Directive).
- The treatment is a “comfort measure”; or
- The order is an instruction regarding hospital transfer; or
- The medical order is a life-sustaining treatment that is being considered for use in a person with advanced progressive illness and/or frailty and has these characteristics:
- is frequently needed by health care professionals (e.g. EMS protocol, emergency department and ICU care, long-term care or hospice); and/or
- is urgently needed by health care professionals (e.g. EMS protocol, emergency department and ICU care; long-term care or hospice); and/or
- requires an informed consent process that is complex (e.g. tube feeding treatment); and/or
- is not effectively specified as “additional orders”.
Consider these additional questions:
- Does the existence of a POLST form mean that the patient has made a decision to forego cardiopulmonary resuscitation (CPR) and has a Do Not Resuscitate (DNR) order? No. The POLST form is based on ensuring goal-based discussions that integrate patient preferences with informed medical decision-making. It is not based on limiting medical interventions. The existence of a POLST form signifies the occurrence of a thoughtful prior conversation and not the presence of a DNR order.
- Does a DNR order imply that a patient does not want treatment? No. Do Not Resuscitate (DNR) does not mean Do Not Treat (DNT). A well-informed patient may recognize the futility of CPR in the presence of advanced or serious illness and may request a DNR order. However, based on their goals for care, the patient may still wish to receive further treatment.
- Is there a difference between a decision to withhold or discontinue life-sustaining treatments? No. There are no ethical or legal distinctions that exist between withholding or withdrawing treatment. If such a distinction existed, patients would refuse treatment fearing that treatment could not be discontinued.