Practitioners Orders for Life Sustaining Treatment (POLST) Information

Improving care through the use of advance directives enables individuals and those closest to them a fuller array of care options. The Practitioners Orders for Life-Sustaining Treatment (POLST) was developed to translate (and make portable) advance directives into a physician’s or nurse practitioner's order that could be followed by clinicians to provide for here and now needs of patients with advanced illness or frailty. 

POLST is a practitioners order about life-sustaining interventions, not an order simply to forgo them. Key to the efficacy of a properly completed POLST is how well orchestrated the conversation(s) is facilitated with patients/families leading to informed choices and identified treatment goals from all possible life-sustaining treatment or less intrusive care that allows natural death. “Researchers concluded based on this first thorough comparative study that the use of POLST offers significant advantages over traditional methods to communicate treatment preferences in the nursing facility setting,” according to an AARP research Report, “Improving Advanced Illness Care: The Evolution of State POLST Programs”

Important Information & Facts POLST vs. DNR

Similarities:

·     Addresses do not resuscitate for both Full Arrest and Pre-Arrest situations.

·     Intended for medically frail or those with chronic or serious illness

Differences:

·     POLST clarifies treatment options for Pre-Arrest emergencies

·     POLST results in a physician order Form Validation

·     Patient name

·     Resuscitation orders (Section “A”)

·     Patient or Legal Representative signature

·     Witness signature

·     Provider name, signature and date

·     All other information is optional

POLST Facilitators

·     Health care providers

·     Licensed, certified, otherwise authorized to provide healthcare in the normal course of business e.g. nurses, social workers, chaplains, administrators, etc.

·     Frequency of Review

·     Minimum annually and definitely when resident’s medical or social health changes. Some facilities

·     have simply incorporated discussion around the POLSTS in their regularly scheduled care conferences.

Changing POLST

·     Completion of a POLST is optional. The person who authorized the form (patient or legal representative) is the individual who can modify it.

·     Persons with decisional capacity can change the POLST at any time to reflect changing circumstances

·     If the patient becomes incapacitated, the agent and the guidelines in a POAHC form play an important role in developing goals for care consistent with the patient wishes in their new state of health. If there is no POA or the POA is unavailable refer to the Illinois Health Care Surrogate Act as to who hierarchically may make changes.

·     Decisions made on behalf of an incapacitated patient should be reviewed with them if/when they regain capacity and modified as directed by the patient.

·     If something was not addressed on the original POLST, it would require filling out a new POLST form because substantive changes cannot be made to an existing form. As noted by Christine Gorka, PhD, Clinical Ethicist, “I would advise that the decisions made by patient on first form be transferred to the second and then additional decisions made by POA/surrogate added. I would also add a statement to the form such as “instructions in Sections A and B based upon decisions made by patient when competent.”

Download the POLST form HERE