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What
is POLST?
Written
By: Jeffrey A. Marshall, CELA*
Pennsylvania's new law on
advance health care directives took effect on
January 29, 2007.
Act 169 of 2006 sets out a comprehensive
set of laws governing health care decision
making for incompetent persons.
Among
the provisions of the new law is a requirement
that the Department of Health determine the
advisability of using a standardized form
containing physician orders detailing the scope
of life-sustaining medical treatment to be
provided to patients.
These orders are commonly referred to as
POLST - Physician-Order-For-Life-Sustaining
Treatment.
The
POLST represents an attempt to more effectively
implement patient decisions regarding
end-of-life care.
Numerous medical and social science
studies suggest that even when living wills and
other forms of advance directives are in place,
they often fail to appropriately direct care
because: (1) the directives don't provide much
guidance; (2) the principal didn't understand
the form he/she signed; (3) the agent doesn't
understand the principal's wishes; (4) health
care providers don't know about or fail to
consult or misinterpret the document.
"[T]he
wishes expressed by an advance directive may in
some cases not be honored due to the
unavailability of completed forms or a health
care professional's inability to quickly
translate the language of the document into
orders for treatment of specific medical
conditions. Health care professionals caring for
persons in various settings may in good faith
initiate or withhold treatments that are
medically not indicated or contrary to the
desires of the person. The Physician Orders for
Life-Sustaining Treatment (POLST) and similar
forms are designed to help health care
professionals honor the treatment wishes of
their patients."1
"POLST
orders provide for continuity of DNR and other
life-sustaining treatment orders from one
setting to another, such as when a patient is
transferred from a nursing facility to a
hospital or vice versa."2
The physician's POLST order is transferred
with the patient when the patient moves to a new
health care delivery setting which helps assure
that the patient's end-of-life decisions are
honored in the new setting. Because the POLST is
in a standardized and unique format and is
already signed by a physician, it is capable of
being implemented at once by any clinician who
encounters it.
As a result, the POLST form of
instruction directive has shown high rates of
compliance and effectiveness.3
"The
POLST is a concise form containing specific
medical instructions that can be acted on
immediately by nurses, doctors, or emergency
personnel; it may include "do not
resuscitate" and "comfort measures
only" orders, and it may indicate whether
to administer CPR (cardio-pulmonary
resuscitation), antibiotics, intravenous fluids,
feeding tubes, artificial respiration, and other
medical interventions. Unlike the living will,
the POLST governs medical issues that are
considered very likely to arise in the near
term. According to its developers, it is really
only suitable for those expecting to die within
the year."4
Even
without the encouragement of Act 169, the POLST
movement has been spreading in Pennsylvania and
throughout the nation.5
Health care providers, patients near the end of
life, and family decision makers should be
receptive to this effective form of combined
physician order and advance directive.
For more information about POLST see http://www.polst.org.
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