What does POLST stand for?
What is POLST?
POLST is part of advance care planning intended for people who are seriously ill or who have advanced frailty. It starts with a talk between the person and their health care provider and can lead to a portable medical order, or POLST form.
What is a POLST form?
A POLST form is a portable medical order. The POLST form is how patients who are seriously ill or have advanced frailty tells all health care providers what they want during an emergency and what their goals of care are given their current medical condition.
What information is on a POLST form?
Orders on a POLST form include:
- Whether you want cardiopulmonary resuscitation (CPR) attempted
- Whether you want to go to the hospital or stay where you are
- Whether you want to receive care in an intensive care unit and be on a breathing machine, if needed
The POLST form is also a way to share your general goals of treatment. These help providers make sure any other medical treatments you may need that aren’t covered on the POLST match your goals.
Should I have a POLST form?
If you are seriously ill or have advanced frailty you may want to talk with your provider about having one. The current standard of care during an emergency is for emergency medical services (EMS) to attempt everything reasonably possible to attempt to save a life. Not all patients who are seriously ill or frail want this treatment and POLST provides the option for them to:
- confirm this is the treatment they want or
- to say what level of treatment they do want.
Beyond emergencies, a POLST tells health care providers what treatments you want and your goals of care so they can match treatments to your goals if you are unable to communicate.
If you are healthy, an advance directive is appropriate.
Where can I get a POLST form?
From your health care provider. Since the POLST form is a medical order, it should be completed and signed by your provider. Before you visit your provider, review our “Getting Ready To Talk About POLST” guide to help you prepare for the conversation.
How do I fill out a POLST form?
A POLST form is a medical order that should be completed by your provider. Patients should not be provided a POLST form to complete on their own. A POLST form should never be completed without a conversation with the patient, or his/her surrogate, about diagnosis, prognosis, treatment options and goals of care.
Does my POLST form need to be signed?
Yes. Your provider must sign the form in order for it to be valid. Most states, and the National POLST Form, also require the patient or the patient’s surrogate (or proxy, health care agent, representative) to sign as well.
What does my POLST form mean?
You and your provider should have talked about what treatments you want prior to your getting a POLST form so hopefully you know. If you want a reminder or something to help you share what your form means with others, see our “What Your POLST Form Means” guide. This guide goes with the National POLST Form so your POLST form may look a little different.
What should I do with my POLST form?
Your provider will give you the original copy of your POLST and will keep a copy in your medical record.
- Carry your POLST with you if you go to a facility.
- If you are home, post it on your refrigerator or put it in your medicine cabinet. Emergency personnel will look for it those places.
- Tell your family and friends you have a POLST form so they can tell emergency personnel to look for it.
- If you are traveling, keep a copy in your purse or wallet near your ID. Emergency personnel will look there to find it.
If you are in a health care setting like a hospital or nursing home, your POLST form will be in your chart. You will be given your original POLST form if you go from one care setting to another.
Am I required to have a POLST form?
No. Everyone should have the right to choose whether they have an advance care plan, including a POLST form. If you are forced or required to complete a POLST form, this violates patient self-determination, informed consent and principles of person and family-centered care. Patients have a right to participate in medical decision-making regarding their treatment plan, including the choice of saying they do not want a POLST form.
However, if you choose not to have a POLST form, that is still a decision and it means you will receive the standard of care. The standard of care means that, during an emergency where you cannot communicate, health care providers will attempt every treatment reasonably possible to save your life. And your surrogate (the person who helps to make medical decisions for you) will be determined by law or by the facility.
Will my POLST form be honored in another state?
Most likely, yes, but there are some limitations. If you are traveling to another state, it is a good idea to take your Advance Directive and your POLST form with you. Both documents, even if not legally binding, will help healthcare professionals know your wishes and a new POLST form can be completed.
If you are moving, you should bring your POLST form with you to your first appointment with your new health care professional to put your wishes on that state’s POLST form. You should also talk to your attorney about updating your advance directive as some states require you use a specific form in order for your advance directive to be valid.
Is POLST a federal program?
No. POLST is not a federal mandate or program but is developed state by state. National POLST is a non-profit, volunteer organization that sets the standards for POLST forms and programs; view PDF showing most states are part of National POLST.
Can I change my POLST form?
You can void your POLST form but, since it is a medical order signed by a provider, you cannot edit it. If you want to change it, talk with your provider. If you want to void it, either draw a line across the form and write “VOID” in larger letters or destroy the form. It is important you tell your provider you voided your form! They need to make sure it is voided in your medical record and, if you live in a state with a POLST registry, that it is removed from the registry.
Does a POLST form replace a Do Not Resuscitate (DNR) order?
In most states, yes. Section A on POLST forms can be a DNR order, also shown as “No CPR” or “DNAR”. In a few states, a DNR order is still required, even if you have a POLST form.
For information about how POLST and DNRs are different, watch this video: How POLST does more than a DNR.
Can a POLST form be used to request medical aid-in-dying?
No. Medical Aid in Dying (MAID), where medication is prescribed to end the life of a terminally ill patient with decision-making capacity, is not considered on any state’s POLST form. POLST should not be used to request MAID.
The National POLST Collaborative does not take a position in support or opposition to MAID, but does recommend for patients considering availing themselves of this legal option in jurisdictions where it is available, that they obtain portable orders requesting no CPR/Do Not Resuscitate from their physician or other authorized practitioner prior to ingestion. See our policy here.
Can my surrogate (or proxy or health care agent or representative) create a POLST form for me or change my POLST form?
In most states, yes. This is why having an advance directive is so important. In your advance directive you identify who you want to make medical decisions for you when you cannot communicate or participate in those discussions. As your medical condition changes, your POLST form may no longer be appropriate and need to be changed. In most states, your provider can talk with your surrogate and change your POLST. Some states restrict what changes a surrogate can make. Check with your POLST Programabout what is allowed in your state.
Don’t advance directives and POLST forms both give medical orders?
Why should I have an advance directive if I have a POLST?
Your advance directive is how you legally name the person who you want to make medical decisions for you when you cannot communicate or participate in those discussions. This person is called a surrogate, a proxy, a health care power of attorney, etc. (it varies by state). You cannot name this person using a POLST form.
In most states your surrogate can make changes to your POLST form. As your medical condition changes, your POLST form may need to be updated and your provider will look at your advance directive to see who they should be talking with about updating your POLST.
Does a POLST form replace an advance directive?
No. Both advance directives and POLST forms are advance care plans. They support each other but do different things. Read more about POLST and Advance Directives.
What if I don’t have a POLST form?
Without a POLST form, providers do not know what treatments you want. You will receive the standard of care, which is what is automatically provided to any patient in a similar situation. During a medical emergency, it means doing everything medically reasonably possible to attempt to save your life. This can mean receiving CPR, transporting you to the hospital, and possibly putting you in the intensive care unit and on a breathing machine, if needed.
Are faxed or photocopies of my POLST form valid?
In almost all states, yes.
What if my provider doesn’t want to sign a POLST form for me?
Some states prohibit providers signing POLST forms for healthy patients. In other cases, providers may be uncomfortable signing a POLST form if they do not know the patient well or are uncomfortable with the choices the patient is making. POLST forms are medical orders and providers can be held accountable if they inappropriately sign a POLST form, just like if they inappropriately sign any other medical order or prescription.
Should the POLST form be used to guide daily care decisions?
Yes. POLST forms do not just guide care during emergencies. The goals of care and medical interventions selected on the form are used to guide decisions regarding artificial nutrition, the use of antibiotics and the provision of other treatments for the patient.
What about Persons with Significant Physical and Developmental Disabilities?
The POLST form is intended for any patient who is seriously ill or has advanced frailty. For patients with significant disabilities, POLST should be considered only when the patient’s level of functioning has become severely impaired as a result of a deteriorating health condition and when intervention will not significantly impact the process of decline.
I’m healthy but I have strong opinions about my treatment wishes. Why shouldn’t I have a POLST?
It is not common for providers to complete POLST forms for healthy individuals and a few states prohibit a provider from completing a POLST form unless their patient is seriously ill or has advanced frailty. Therefore, this is something you need to discuss with your provider since it is their medical license that is at risk for signing a POLST form (medical order).
POLST was created to help people who have a medical condition that means they expect to have a medical emergency at some point. These people, because they are sick and/or frail, are able to have a specific conversation with their provider about what treatment options are available to them and what it will mean for them. For example, if a patient has a chronic heart condition, they can talk to their provider about what will happen if they have a heart attack (expected for their condition) and what will likely happen if they have CPR or are transferred to the intensive care unit (ICU).
If you are healthy, the standard of care is to provide all reasonable treatment possible to attempt to save your life. There is no need to complete a POLST form to get this level of treatment