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Section 6 - The POLST Program: A Simple Approach
to Communicating Your Patient's Medical Care Decisions
When it comes time to determine what type of care an individual
wants ordered by her or his physician in preparation for possible
life-threatening medical events, there is often a tremendous amount
of effort and emotion. The Physician Orders for Life-Sustaining
Treatment (POLST) form is a tool for streamlining this process and
ensuring a patient's end of life care decisions are made known to
health care providers, family members and emergency personnel.
Washington state agencies and associations support the POLST form
and it has been used successfully in Oregon state for over five
years. Both the Washington State Department of Health (DOH) and
the Washington State Department of Social and Health Services (DSHS)
support the POLST form. The Washington State Medical Association's
Patient Awareness and Community Education Program provided a grant
backing the program during its introduction in our state. The POLST
form is endorse by the Washington State Medical Association, Washington
State Hospital Association and the Association of Washington Public
Hospital Districts endorse the POLST form.
Initially, the POLST form was introduced in Washington state as
a DOH sponsored pilot project in Spokane and Whitman counties. Participating
hospitals and nursing homes adopted the POLST form and reported
that it was used successfully and was met with positive feedback
from health care providers. Policies and procedures for using the
POLST form were in-serviced to EMS personnel, hospitals, nursing
homes, and home nursing staff during the pilot project.
At this stage, DOH will authorize the POLST form's use in any Washington
county that would like to use it. DSHS supports the POLST form in
nursing homes. For an example of a DSHS approved POLST implementation
policy, please see the policy from St. Joseph Care Center included
in these materials.
The POLST form is a simple and straightforward two-sided form that
asks relatively brief questions regarding the type of care a patient
wants in the event of an emergency or during the final stages of
life.
The POLST form is not an advance directive. It is actually a physician
order form that requires the signature of both the physician and
the patient or the patient's legal surrogate. The POLST form may
complement an advance directive.
The form is appropriate for any patient, but especially for anyone
who is a "No Code," "DNR," or has orders limiting
medical interventions. Also, doctors who foresee a possibility their
patient may not live through the year based on the patients medical
condition should recommend a POLST form be filled out. The form
should accompany the patient during a transfer - for example, to
a hospice, home, or nursing home.
The pilot project demonstrated that EMS personnel could easily
recognize and follow the physician orders outlined on the POLST
form. One obstacle both health care providers and emergency personnel
encountered during the pilot project was POLST forms that lacked
either a doctor or patient (or the patient's legal surrogate) signature.
This problem was handled by allowing a faxed signature to act as
a substitute by stapling it to the form as an addendum.
Following this introduction are materials intended to assist your
facility with implementing the POLST form. Included in this section
are the following:
- Introductory sheets on the POLST form;
- The DSHS approved policy and procedures guidelines for implementing
the POLST forming in nursing homes (developed by St. Joseph Care
Center);
- Guidelines for nurses (developed by Sacred Heart Medical Center);
and
- The POLST form.
The POLST form included in this section may be photocopied and
used as is. We encourage you to use the same lime green color, as
it will satisfy both DOH and emergency personnel. The bright color
also increases the form's visibility, facilitating its use and transfer
with the patient. Cardstock may be used, but it will hamper faxing.
You may obtain more information by contacting Dr. Jim Shaw at the
Providence Center for Faith and Healing, (509) 474-3008.
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