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What is POLST? Physician Orders for Life Sustaining Treatment.

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Presentation on theme: "What is POLST? Physician Orders for Life Sustaining Treatment."— Presentation transcript:

1 What is POLST? Physician Orders for Life Sustaining Treatment

2 California POLST Education Program © April 2011 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 2 Why POLST? 1.Patient wishes often are not known. – The Advance Healthcare Directive (AHCD) may not be accessible. – Wishes may not be clearly defined in AHCD. 2.Allows healthcare providers to know and honor wishes for end-of-life care.

3 California POLST Education Program © April 2011 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 3 Case Study: What We Know

4 California POLST Education Program © April 2011 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 4 Case Study: What We Didn’t Know ©California Medical Association 2000-2009

5 California POLST Education Program © April 2011 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 5 Case Study: What Happened  AHCD not transferred with patient.  DNR wishes not documented.  Over-treatment against patient wishes.  Unnecessary pain and suffering.

6 California POLST Education Program © April 2011 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 6 What is POLST?  A physician order recognized throughout the medical system.  Portable document that transfers with the patient.  Brightly colored, standardized form for entire state of CA.

7 California POLST Education Program © April 2011 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 7 What is POLST?  Allows individuals to choose medical treatments they want to receive, and identify those they do not want.  Provides direction for healthcare providers during serious illness.

8 California POLST Education Program © April 2011 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 8 Who Would Benefit from Having a POLST Form?  Chronic, progressive illness  Serious health condition  Medically frail  Tool for determination – “You wouldn’t be surprised if this patient died within the next year.”

9 California POLST Education Program © April 2011 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 9 POLST History  POLST development began in Oregon in 1991.  Expanded to more than half of US states.

10 Developing Programs *As of January 2011 National POLST Paradigm Programs Endorsed Programs No Program (Contacts) Designation of POLST Paradigm Program status based on information available by the program to the Task Force.

11 California POLST Education Program © April 2011 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 11 POLST Success  Oregon study of 180 Skilled Nursing Facility (SNF) patients: – POLST stated No CPR and Comfort Measures Only. – Patient wishes were honored.  More research available at www.polst.org.

12 California POLST Education Program © April 2011 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 12 POLST in California  The Coalition for Compassionate Care of California (CCCC) is lead agency.  Support from California HealthCare Foundation.  Grassroots efforts of local POLST coalitions and communities.

13 California POLST Education Program © April 2011 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 13 POLST in California Effective January 1, 2009

14 California POLST Education Program © April 2011 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 14 POLST in California  One form for entire state.  Use not mandated.  Honoring form is mandated.  Provides immunity from civil or criminal liability.

15 California POLST Education Program © April 2011 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 15 POLST vs. Advance Healthcare Directive  POLST complements the Advance Healthcare Directive (AHCD).  Both are legal documents.

16 California POLST Education Program © April 2011 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 16 POLST vs. Advance Healthcare Directive POLSTAHCD  For seriously ill/frail, at any age  For anyone 18 and older  Specific orders for current treatment  General instructions for future treatment  Can be signed by decisionmaker  Appoints decisionmaker

17 California POLST Education Program © April 2011 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 17 Where Does POLST Fit In? Advance Care Planning Continuum Complete an Advance Directive Complete a POLST Form Age 18 End-of-Life Wishes Honored Diagnosed with Serious or Chronic, Progressive Illness (at any age) Update Advance Directive Periodically C O N V E R S A T I O N

18 California POLST Education Program © April 2011 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 18 POLST vs. Pre-Hospital DNR (Do Not Resuscitate)  Similarities: – Physician orders. – Address Do Not Resuscitate. – Intended for medically frail or those with chronic or serious illness.

19 California POLST Education Program © April 2011 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 19 POLST vs. Pre-Hospital DNR (Do Not Resuscitate) POLSTPre-Hospital DNR  Allows for choosing resuscitation  Can only use if choosing DNR  Allows for other medical treatments  Only applies to resuscitation  Honored across all healthcare settings  Only honored outside the hospital

20 California POLST Education Program © April 2011 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 20 POLST vs. PIC (Preferred Intensity of Care) POLSTPIC  Consistent form for CA  PIC form is different in every SNF  Is a medical order  Is not a medical order; similar to a doctor’s note  Honored across all healthcare settings  Only honored within the SNF

21 California POLST Education Program © April 2011 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 21 POLST vs. PIC (Preferred Intensity of Care)  Both include choices for medical interventions.  POLST can replace the PIC form at SNF.

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24 California POLST Education Program © April 2011 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 24 CA POLST Form – Front Side

25 California POLST Education Program © April 2011 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 25 Section A: CPR

26 California POLST Education Program © April 2011 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 26 Section B: Medical Interventions

27 California POLST Education Program © April 2011 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 27 Diagram of POLST Medical Interventions CPR Full Treatment* DNR Comfort Measures Limited Interventions *Consider time/prognosis factors under “Full Treatment” “Defined trial period. Do not keep on prolonged life support.”

28 California POLST Education Program © April 2011 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 28 Section C: Artificial Nutrition

29 California POLST Education Program © April 2011 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 29 The POLST Conversation  POLST is not just a check-box form.  The POLST conversation provides context for patients/families to: – Make informed choices. – Identify goals of treatment.

30 California POLST Education Program © April 2011 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 30 Section D: Information and Signatures

31 California POLST Education Program © April 2011 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 31 Who Can Speak for the Patient?  Surrogate decisionmaker/agent  Parent, guardian, conservator  Closest available relative

32 California POLST Education Program © April 2011 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 32 CA POLST Form – Back Side

33 California POLST Education Program © April 2011 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 33 Who Can Help Complete POLST?  Healthcare providers – “licensed, certified, or otherwise authorized to provide healthcare in the normal course of business.”  Best practice suggests use of those trained in the POLST Conversation: – Physicians – Nurses – Social Workers – Chaplains – Social Service Designees

34 California POLST Education Program © April 2011 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 34 Directions – Completing POLST

35 California POLST Education Program © April 2011 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 35 Directions – Using POLST

36 California POLST Education Program © April 2011 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 36 Directions – Reviewing/Modifying/Voiding POLST

37 California POLST Education Program © April 2011 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 37 When Should POLST be Reviewed?  Transfer from one care setting to another.  Change in patient’s health condition.  Patient’s treatment preferences change.  Patient Care Conference.

38 California POLST Education Program © April 2011 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 38 Can POLST be Changed?  Individual with capacity can request alternative treatment or revoke a POLST at anytime.  Legally recognized decisionmaker may request change based on condition change or new information regarding patient wishes.

39 California POLST Education Program © April 2011 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 39 Original pink POLST stays with patient  At SNF/Hospital: – File in medical chart (with AHCD). – Send original with patient upon return to home/SNF/hospital. – Keep copy if resident transferred; review POLST upon resident’s return. Where Should We Keep POLST?

40 California POLST Education Program © April 2011 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 40  At home: – Post in easy-to-find location (with AHCD). – Give to EMS to transport with patient. Where Should We Keep POLST?

41 California POLST Education Program © April 2011 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 41 POLST: Depth of the Process  POLST is more than a form.  POLST: – Facilitates rich conversations with patients/families. – Complements the AHCD. – Incorporates the depth of comfort care.

42 California POLST Education Program © April 2011 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 42 California POLST Project C oalition for The Coalition for Compassionate Care of California (CCCC) provides leadership and oversight for POLST outreach activities in California, with support from the California HealthCare Foundation. C ompassionate C are of C alifornia

43 California POLST Education Program © April 2011 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 43 POLST C onversation A rich conversation with each individual patient C omprehensive Education To promote excellent conversational skills with patients and families C onsistent Form Standardized form recognized across care settings Translating an individual’s wishes for care during serious or chronic illness into medical orders that honor those preferences for medical treatment. C ommunity Collaboration Integrating POLST into the community standard of care California POLST Project

44 California POLST Education Program © April 2011 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 44 California POLST Form  Available at www.caPOLST.org – Translations available  May be purchased from: – www.med-pass.com (bulk forms/paper) – www.cmanet.org (POLST Kit) ©California Medical Association 2009

45 California POLST Education Program © April 2011 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 45 California POLST Form  Print on Ultra Pink, 65# card stock paper  Copies/faxes on any color paper are acceptable Focus on the conversation

46 California POLST Education Program © April 2011 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 46 POLST Resources  Provider and Consumer Brochures  FAQs  Videos

47 California POLST Education Program © April 2011 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 47 POLST Resources  Model policies and procedures  Standardized educational curriculum  Local POLST coalitions  www.caPOLST.org

48 Questions?


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