1. The Indiana POST Program: An Overview

2. The POST Program POST = Physician Orders for Scope of Treatment – Converts treatment preferences into immediately actionable medical orders – Preferences to have or decline treatments – Transfers across treatment settings with patient – Recognizable, standardized form 2

4. POST Paradigm Programs Source: www.polst.org Dark pink = endorsed Light pink = developing White = no activity

5. Research on POST POST supports patient-centered care by expanding beyond DNR/full code orders (Hammes et al., 2012; Hickman et al., 2004; 2009) POST is more effective than traditional approaches at ensuring treatment preferences are documented as orders (Hickman et al., 2010); POST orders do change the kinds of treatments patients receive (Hickman et al., 2010); Treatments provided are largely consistent with POST orders (Hickman et al., 2011); POST is viewed as helpful by clinicians including EMTs and hospice personnel (Schmidt et al., 2004; Hickman et al., 2009)

6. The Indiana POST Program Indiana Patient Preferences Coalition – Mission: To develop a standardized tool to record patient wishes as medical orders that transfer across treatment settings with a goal of honoring individual preferences for care. Membership of 60+ representing key stakeholder groups 6

7. Legislative History 2012 Session - HB 1114 – Did not make it out of committee 2013 Session - HB 1182 – Passed Indiana House 99-0 – Passed Indiana Senate 48-1 with amendments – Concurrence passed 95-0 – Signed into law (IC

8. Who can have a POST? Must have one (or more) of the following conditions: – An advanced chronic progressive illness – An advanced chronic progressive frailty Note: Frailty is a medical diagnosis – A terminal condition – Unlikely to benefit from CPR Would the patient’s physician be surprised if the patient died within the next 12 months?

9. Who can fill out a POST form with a patient? – Physician or his/her designee (TBD by physician) – Requires physician signature to execute the order – Physician must provide license number, address, and phone number – Form must be signed by the patient or their legally authorized representative

10. What if the patient lacks decisional capacity? A POST form can be filled out based on a conversation with: – An appointed health care representative; – An individual's attorney in fact with authority to consent to or refuse health care for the individual; – A legally appointed guardian (includes parents of minor) Decisions must be based on prior known wishes or best interest of patient

11. How does the POST work in the hospital setting? – POST is valid in ALL settings – Should follow in emergency department setting unless orders appear invalid or alternative treatment is requested by patient/representative – Admission orders should be consistent with POST orders – POST orders should be used to guide treatment decisions including level of aggressiveness of intervention in hospital – Individual hospitals should develop policies and procedures re POST