What is POLST?
POLST, which stands for "Physician Orders for Life-Sustaining Treatment," is a physician order that helps give seriously ill patients more control over their end-of-life care. In Maine, it is produced on a distinctive bright green form and signed by both the doctor and patient. POLST specifies the types of medical treatment that a patient wishes to receive towards the end of life. As a result, POLST can prevent unwanted or medically ineffective treatment, reduce patient and family suffering, and help ensure that patients' wishes are honored.
Where can one learn more about POLST and obtain a POLST form?
General information is available from the National POLST Paradigm Initiative Task Force (www.polst.org). For additional information, please contact Dr. Ira Mandel at 594-9561, Medical Director of Kno-Wal-Lin Hospice and Palliative Care.
Additional contact information:
- Kno-Wal-Lin – Anna Peterson – 594-9561
- Penobscot Bay Medical Center – Mary Beth Hill – 596-8493
- Quarry Hill – Janet O'Brien –230-6236
- Knox Center – Anne Norman – 594-6852
How does POLST help the patient?
- Documents a patient's wishes for life-sustaining treatment in the form of a signed physician order.
- Eases the transfer of patient records between facilities.
- Clarifies treatment desired by the patient and minimizes confusion about patient preferences.
- Helps put into action the intent of a patient's Healthcare Advance Directive.
- Maximizes comfort care of all patients.
- Allows orders to be reviewed and changed periodically as appropriate by patient values and medical circumstances.
How does POLST help healthcare providers?
- Ensures readily available information about the patient's treatment preferences.
- Provides a system for communicating the physician's medical orders for the patient to other care facilities.
- Is an effective instrument that prevents unwarranted treatments and helps ensure that medically indicated treatments desired by the patient are provided.
- Provides a practical way to assemble patient information on a double-sided form.
- Allows periodic review and changing of orders as indicated by patient values and medical circumstance.
What is the POLST form?
The POLST form, which is preferably to be printed on heavy stock bright green paper, provides default orders in the event a patient become seriously ill. Specifically, the POLST form includes information whether to:
- Attempt cardiopulmonary resuscitation,
- Administer antibiotics,
- Use a ventilator to help with breathing,
- Provide artificial nutrition by tube or by IV.
In addition, the POLST form provides guidance regarding the amount of medical care desired by the patient, in general. For instance, some patients may want to be put on a ventilator if it could possibly improve their health outcome while other patients may express a desire not to be hospitalized under any circumstance other than that necessary to relieve suffering that cannot be treated at home.
Why should a POLST form be completed?
In general, POLST both helps patients and their healthcare professionals to discuss and develop concrete plans that accurately reflect patients' preferences concerning end of life care and then succinctly and clearly convey those plans to other healthcare professionals, facilities, and emergency personnel.
Who Should Have a POLST form?
POLST is designed for seriously ill individuals, or those who are in very poor health, regardless of their age, to make decisions about life sustaining treatment before they experience medical emergencies. The form is recommended even for patients who have an advance directive, because it provides greater detail about what treatment a patient may want in an emergency. It is be appropriate for patients who have strong personal beliefs about their health care preferences and who wish that their preferences be known to their treating physicians.
A POLST form may be completed when a patient is diagnosed with a terminal illness, experiences a significantly compromising illness, or becomes frail. A POLST form may be completed as part of a regular medical appointment, at any point in which end-of-life planning is appropriate, or as part of discharge planning from the hospital. A POLST form may be completed for any patient at any time, upon the patient's request, regardless of the patient's current health status.
What is the procedure for completing a POLST form?
A POLST is to be completed by the patient's physician or by a healthcare provider (such as a nurse or social worker) who has undergone special training about how to complete a POLST form and who works with the patient's physician in conjunction with a thorough conversation with the patient regarding the patient's current and future health conditions and associated treatment preferences.
After such conversation, both the patient and the physician must sign the POLST. The procedure for completing a POLST form may be initiated by either the physician or the patient. The health professional completing the POLST form will document in the patient's medical record that a POLST form has been completed. The physician who signs the POLST form is responsible for reviewing the various treatment options on the POLST form to assure they are in keeping with the patient's preferences.
When is a POLST form actually used?
The POLST form may be used to guide treatment when a patient is at home, in a long-term care facility, in transit between locations, or as a directive when a patient arrives at an Emergency Department or is admitted into an acute care facility.
What if a patient can no longer communicate her/his wishes for care?
Having prior meaningful discussions between the patient (when they were still capable) and Health Care Power of Attorney* or next of kin, as appropriate to Maine State laws, usually makes clear the wishes of the patient and avoids this infrequent situation. However when this does occur, the surrogate's wishes should be respected. The goals of care can be explored further once the patient is stable and preferably with the patient's health care professional that knows them well.
*Visit the web site for Maine Office of the Attorney General or go to this website for more information on selecting a Power of Attorney for Health Care: http://www.themha.org/issues/advdirectivesform.pdf
It is necessary for the treating physician to assure POLST orders are made with input from the person who has the authority to speak in the patient's behalf. The person who has the authority to make health care decisions when you are unable is you Health Care Power of Attorney (HCPOA), also known as your "agent."
If you have not designated an agent, Maine's advance directive statute defines the surrogate in this priority: a guardian appointed by a judge, spouse (unless legally separated), someone with whom you share an emotional, physical and financial bond similar to a spouse, your adult children, your parents, your adult brothers and sisters, your adult grandchildren, your adult nieces and nephews and your adult aunts and uncles.
If your physician cannot reach one of these family members, she/he may ask another adult relative or good friend who knows your values. If there are family members or others whom you do not want making decisions for you, make sure you put this in writing and tell your physician.
Where should a patient's POLST form be kept?
If a patient lives at home, the original green POLST form should be kept where emergency responders can find it. If a patient lives at a long-term care facility, the POLST form will be kept in the patient's chart. When a patient arrives at the hospital, the original green POLST form should placed in the chart and be used to establish initial orders.
Can the directives contained on a POLST form be changed?
The POLST form may be changed by revoking the current version and completing a new POLST form. Changes may be made by the patient at any time and in any manner that communicates his or her intent.
Will Penobscot Bay Medical Center accept POLST orders from physicians without admitting privileges?
Yes, POLST orders will be accepted from physicians without admitting privileges on the condition that the content of the POLST form be reviewed by Penobscot Bay Medical Center admitting physician to assure the preferences of the patient are still valid. If new information regarding the health of the patient is identified or the patient elects to communicate changes in treatment preferences, new orders regarding life-sustaining treatment will be written, dated and signed.
When Should a POLST Form be reviewed and/or replaced?
The POLST form should be reviewed when a patient's condition or wishes change and/or if the patient is transferred from one care facility to another.
Does the POLST form replace traditional Advance Directives?
The POLST form complements an Advance Directive and is not intended to replace that document. An Advance Directive is still necessary to appoint a legal health care decision maker, and is recommended for all adults, regardless of their health status.
Visit the web site for Maine Office of the Attorney General or go to this website for more information on selecting a Power of Attorney for Health Care: http://www.themha.org/issues/advdirectivesform.pdf
If a patient has a POLST form and an Advance Directive that conflict, which takes precedence?
If there is a conflict between the documents, the more recent document would be followed.
Visit the web site for Maine Office of the Attorney General or go to this website for more information on selecting a Power of Attorney for Health Care: http://www.themha.org/issues/advdirectivesform.pdf
Is POLST required by law?
Filling out a POLST form is an entirely voluntary process carried out between interested patients and their healthcare team.
What happens if I don't have a POLST form?
Without a POLST form, emergency medical personnel, nurses and doctors would not know your treatment wishes. You will most likely receive all possible treatments, whether you want them or not. Talking about your treatment choices with your loved ones and doctor before a problem occurs can guide them and help ensure you get the care you want.
Is a copy of the POLST form valid?
Yes.
Is a faxed POLST form valid?
Yes.
Does the POLST form expire?
No. The POLST form should be reviewed when a patient's condition or wishes change or they are transferred from one care facility to another but it does not expire. Health care systems or facilities may establish guidelines for periodic review.
Is a Maine POLST form valid in other states?
Generally, in other states, the POLST orders are followed and emergency medical services and hospitals should have policies that help first responders respect the patient's wishes provided as orders on the form.
Can a POLST form be used for minors?
Yes. Thankfully, it is rare that a child develops a life-threatening illness. When this does occur, the POLST form can be used by the child's health care professional to help emergency medical personnel, other members of the treatment team know the goals of care and respect the parent's wishes as the child's health status declines.
Where can one learn more about POLST and obtain a POLST form?
General information is available from the National POLST Paradigm Initiative Task Force (www.polst.org). For additional information, please contact Dr. Ira Mandel at 594-9561, Medical Director of Kno-Wal-Lin Hospice and Palliative Care.
Additional contact information:
- Kno-Wal-Lin – Anna Peterson – 594-9561
- Penobscot Bay Medical Center – Mary Beth Hill – 596-8493
- Quarry Hill – Janet O'Brien –230-6236
- Knox Center – Anne Norman – 594-6852
Patients may request a copy of the POLST the form from their health care provider. It is important for patients to discuss their goals of treatment with their health care provider so they can decide if POLST is right for them, and how they can document their decisions appropriately for documenting on the form. Please visit www.penbayhealthcare.org web site to order forms online, or contact Prudy Netzorg at 594-9561.
Updated: 2010-04-26