Chart: POLST & Advance Directives
Does a POLST form replace an advance directive?
No. A POLST form complements the advance directive — it does not replace it.
All adults should have an advance directive but an advance directive does not give medial orders. Instead, it provides an idea of what treatments the patient would like to receive and identifies a surrogate who can help make treatment decisions on behalf of the patient.
A POLST form gives medical orders. A surrogate identified in an advance directive can help complete a POLST form on behalf of a patient.
How is an advance directive different from a POLST form?
A POLST form is a medical order that tells emergency health care professionals what to do during a medical crisis where the patient cannot speak for him or herself. An advance directive is a legal document that tells who the patient wants making medical treatment decisions for him/her when he/she cannot speak and gives general directions on treatments the patient does or does not want to help create a treatment plan.
POLST Paradigm Form | Advance Directive | |
---|---|---|
Type of Document | Medical Order | Legal Document |
Who Completes | Health Care Professional | Individual |
Who Needs One | Seriously ill or frail (any age) view guidance | All competent adults |
Appoints a Surrogate | No | Yes |
What is Communicated | Specific medical orders for treatment wishes during a medical emergency | General wishes about treatment wishes. May help guide treatment plan after a medical emergency. |
Can EMS Use | Yes | No |
Ease in locating | Very easy to find. Patient has original. Copy is in medical record. Copy may be in a Registry (if your state has a Registry). | Not very easy to find. Depends on where patient keeps it and if they have told someone where it is, given a copy to surrogate or to health care professional to put in his/her medical record. |
Who should have these documents?
All adults should have an advance directive. 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.
There is no age restriction on who may have a POLST form (except in Colorado, Michigan & South Carolina where the form is not allowed to be used by a minor).
Does a patient need an advance directive to have a POLST form?
No, but it is strongly recommended! If the patient is capable of a POLST discussion, the patient is also likely capable of appointing a surrogate and should be encouraged to do so. If the patient ever loses decision-making capacity, it is the surrogate the patient named in his/her advance directive who is able to create, modify, or void a POLST form.
Can a patient use a POLST form to designate a legal surrogate?
No. Only an advance directive may be used to appoint a surrogate. However, most POLST forms ask for this information on the second side of the form and this information should also be reviewed and updated whenever the form is reviewed with the patient.