POLST is the acronym for Physician Orders for Life-Sustaining Treatment. Depending upon the state where you reside, the form could be called: MOLST (Medical Orders for Life Sustaining Treatment); a MOST (Medical Orders for Scope of Treatment); a POST (Physician Orders for Scope of Treatment – In Iowa, this is a IPOST and in the state of Louisiana, it is a La POST); a COLST (Clinical Orders for Life Sustaining Treatment); a SMOST (Summary of Physician Orders for Scope of Treatment) or a TPOPP (Transportable Physician Order for Patient Preference).
Why are we featuring this topic today? Advance Care Planning is a topic for anyone of age. It’s important for your wishes to be known. Life’s interruptions can happen at any age. There has been confusion as to what exactly the POLST is, thus it seemed timely to cover this topic.
Had to laugh with this picture! How many times has this been your response to a doctor?!
Back to the information!
To be clear, Advanced Care Directives differ from the POLST, in that the POLST is used only for patients with a chronic/progressive illness or frailty. Advanced Care Directives are for everyone (young, old, well, ill) as a “just in case” way to relay your wishes to those you select to speak and act on your behalf.
Other differences between the two include: the POLST form is a set of medical orders, similar to the do-not resuscitate (DNR) order. POLST is not an advance directive. POLST does not substitute for naming a health care agent or durable power of attorney for health care.
In researching the origin of the POLST form; a key component of the POLST form is thoughtful, facilitated advance care planning conversations between health care professionals and patients and those close to them to determine what treatments patients do and do not want based on their personal beliefs and current state of health. In these conversations patients are informed of their treatment options and, if they wish, their health care professional completes a POLST form based on the patient’s expressed treatment preferences. This is a shared decision making model.
State law authorizes certain health care professionals to sign medical orders; the POLST form is signed by those health care professionals who are accountable for the medical orders. Whereas in an Advance Directive, the patient identifies a surrogate decision-maker and provide guidelines and values underlying a patient’s wishes; the POLST forms turn those wishes into medical actions ordered by a physician. The two are complementary in every sense.
One barrier to implementing both Advance Directives (ADs) and POLST orders is the challenge of accessing them in a timely manner in emergency medical situations when they are most needed. POLST orders in particular can be critical to making important determinations such as whether or not to: transfer a patient to a hospital; initiate intubation and mechanical ventilation; or attempt resuscitation after cardiac arrest. There may be only minutes in which to make these vital decisions.
The value of a physician knowing what a patient desires is immeasurable. In the case of an accident or emergency, patient preferences may not be known. Idaho, New York, Oregon, West Virginia have implemented registries and 18 other states use the POLST form.
If you are interested in learning more about the POLST forms and use in your state, this website is a resource: http://www.polst.org/programs-in-your-state/
The Living Planner supports individuals, developing business owners and employees. Well-being begins by knowing who you are, where you are, what your wishes are and developing strategies to move forward having access to resources and support when needed. Contact us to learn more about how we work with individuals, business owners and employees to identify precautionary measures you can take at home, work and in life via Email or online @ The Living Planner