Pennsylvania and New Jersey Departments of Health have published practitioner or physician orders for life sustaining treatment (POLST) forms which allow patients more control over their end-of-life care. The POLST form specifies the types of medical treatment that a patient wishes to receive toward the end of life.
These medical orders are signed by the patient’s physician, physician’s assistant or nurse practitioner, and the patient or the patient’s surrogate. The POLST form travels with the patient to ensure that treatment preferences are honored across various healthcare settings including hospitals, nursing homes, assisted living.
Why you should use a standardized POLST form?
It is advised that a person who wishes to utilize a POLST adopt the form developed by the Department of Health for their state. These forms are designed to be consistent with state law and there are significant advantages to using a form that contains standardized language in a recognizable format.
The form documents the type of treatments that a seriously ill person wants at the end of life.
Who should consider a POLST?
The form is intended for the following types of patients:’
- Those near death
- Those with increased risk of experiencing a medical emergency based on their current medical condition
- Those who wish to make clear their treatment preferences including CPR, mechanical ventilation, ICU
- Those who have had multiple unplanned hospital admissions in the last 12 months typically coupled with increasing frailty, decreasing function, and progressive weight loss
POLST vs. DNR
It’s important to understand that a POLST, unlike an out of hospital—Do Not Resuscitate Order (OOH DNR) cannot be following and CPR could be initiated until medical command is contacted.
A DNR and POLST are similar in that they both address resuscitation and are considered medical orders. While a POLST may be signed by a physician, physician assistant, or nurse practitioner, only an attending physician may execute a DNR. In addition, a critical difference between a DNR and a POLST is that a DNR requires that a person is in end stage medical condition or permanently unconscious.
Further, a DNR is limited to resuscitation while a POLST is designed to document an individual’s treatment choices for end-of-life care whether that choice is for resuscitation or no resuscitation. A POLST also addresses choices for full or limited medical treatment or comfort measures only.
Communication is always encouraged between a transferring facility and a receiving facility with regards to a DNR or a POLST to confirm that the proper resources are available for continuity of care.
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