DO YOU HAVE A POLST?
What does “POLST” stand for? POLST stands for Practitioner Orders for Life-Sustaining Treatment and is designated for seriously ill patients or those who are medically frail with limited life expectancy, regardless of their age.
Governor Christie signed legislation on 12/21/11 that will enable patients to indicate their preferences regarding life-sustaining treatment. The law calls for the creation of a standardized Practitioner Orders for Life Sustaining Treatment (POLST) form that is signed by a patient's attending physician or advanced practice nurse and provides instructions for health care personnel to follow for a range of life-prolonging interventions. This form becomes part of a patient's medical records, following the patient from one healthcare setting to another, including hospital, home, nursing home, or hospice.
The POLST complements an Advance Directive and is not intended to replace that document. An Advance Directive may still be necessary to appoint a legal healthcare decision maker and is recommended to all adults, regardless of their health status.
The POLST was developed in response to seriously ill patients receiving medical treatments that were not consistent with their wishes. The goal of the POLST is to provide a framework for healthcare professionals so they can provide the treatments patients DO want and avoid those treatments that patients DO NOT want.
The values expressed on both documents should be the same. If there is a conflict between the two documents, a conversation with the patient or surrogate should take place to determine the most current preference as soon as possible. The POLST and the Advance Directive can then be updated based on these more current treatment choices. If this cannot be done and a crisis ensues, care should be provided in accordance with the most recent document.
Documentation on the POLST from includes:
- Goals of care for the patient.
- Preferences regarding cardiopulmonary resuscitation attempts.
- Preferences regarding use of intubation and mechanical ventilation for respitory failure.
- Other specific preferences regarding medical interventions that are desired or declined.
The POLST form is green and may be found on the internet. Faxed copies and photocopies are valid, however, green paper is preferred and should be used to distinguish the form from other forms in the patient’s medical record.
The site for the form is www.nj.gov/health/advancedirective/polst.shtml
The original POLST, on green paper, stays with the patient at all times. In the acute care or long term care settings, the original form should be kept in the patient’s medical record or file in the doctor’s order section and copies should be made or scanned into the medical record to maintain.
The POLST can be modified or rescinded by a patient with decision-making capacity, verbally or in writing, at any time.
Having a conversation with a client about end-of-life issues is an important and necessary part of good planning.