California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 11 What is POLST? Physician Orders for Life Sustaining Treatment

California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 22 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. – The AHCD is not a physician order. 2.Allows healthcare providers to know and honor wishes during serious illness.

California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 33 Case Study: What We Know

California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 44 Case Study: What We Didn’t Know ©California Medical Association

California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 55 Case Study: What Happened  AHCD not transferred with patient.  DNR wishes not documented.  Over-treatment against patient wishes.  Unnecessary pain and suffering.

California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 66 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.

California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 77 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.

California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 88 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.”

California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 99 POLST History  POLST development began in Oregon in  Expanded to more than half of the United States.

Developing Programs National POLST Paradigm Programs Endorsed Programs No Program (Contacts) *As of January 2014 Mature Programs Regionally Endorsed Program Programs That Do Not Conform to POLST Requirements

California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 11 POLST Success Oregon Study: Location of Death and POLST Orders 58,000 deaths reviewed, 31% had POLST in Oregon Registry Patient treatment choices honored, including avoiding dying in hospital Fromme EK, JAGS 2014

California POLST Education Program ©August 2014 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.

California POLST Education Program ©August 2014 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

California POLST Education Program ©August 2014 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. AB 3000, Wolk. Part 4, Sec 7, Probate Code Section 4782

California POLST Education Program ©August 2014 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).  POLST is not intended to replace the AHCD.  Both are legal documents. AB 3000, Part 4, Sec 3, Probate Code 4780 (3) (c)

California POLST Education Program ©August 2014 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  Physician orders for medical treatment  Can be signed by decisionmaker  For anyone 18 and older  General instructions for treatment  Appoints decisionmaker

California POLST Education Program ©August 2014 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 Treatment Wishes Honored Diagnosed with Serious or Chronic, Progressive Illness (at any age) Update Advance Directive Periodically

California POLST Education Program ©August 2014 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.

California POLST Education Program ©August 2014 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  Allows for other medical treatments  Honored across all healthcare settings  Can only use if choosing DNR  Only applies to resuscitation  Only honored outside the hospital

California POLST Education Program ©August 2014 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  Is a medical order  Honored across all healthcare settings  PIC form is different in every SNF  Is not a medical order; similar to a doctor’s note  Only used within the SNF

California POLST Education Program ©August 2014 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.  POLST is a voluntary form.

California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 24 CA POLST Form – Front Side

California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 25 Section A: CPR

California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 26 Section B: Medical Interventions

California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 27 Diagram of POLST Medical Interventions CPR Comfort-Focused Treatment DNR Full Treatment* Selective Treatment *Consider time/prognosis factors under “Full Treatment” “Trial Period of Full Treatment” may be checked if prolonged life support is not desired.

California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 28 Section C: Artificially Administered Nutrition

California POLST Education Program ©August 2014 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.

California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 30 Section D: Information and Signatures

California POLST Education Program ©August 2014 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, registered domestic partner, guardian, conservator  Closest available relative

California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 32 CA POLST Form – Back Side

California POLST Education Program ©August 2014 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, Nurse Practitioners, Physician Assistants – Social Workers – Chaplains – Social Service Designees

California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 34 Directions – Completing POLST

California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 35 Directions – Using POLST

California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 36 Directions – Reviewing/Modifying/Voiding POLST

California POLST Education Program ©August 2014 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.  Recommendation: Update POLST forms to the 2014 version when reviewing 2009 or 2011 POLST forms.

California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 38 Can POLST be Changed?  Patient with capacity can request alternative treatment or revoke a POLST at anytime.  Legally recognized decisionmaker may request a change based on condition change or new information regarding patient wishes.

California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 39 Where Should We Keep POLST? 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 patient transferred; review POLST upon patient’s return.

California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 40 Where Should We Keep POLST?  At home: – Post in easy-to-find location (with AHCD). – Give to EMS to transport with patient.

California POLST Education Program ©August 2014 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 importance of comfort.

California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 42 California POLST Project 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 oalition for C ompassionate C are of C alifornia

California POLST Education Program ©August 2014 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

California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 44 California POLST Form  Available at – Translations available  May be purchased from: – (bulk forms/paper) – (POLST Kit)

California POLST Education Program ©August 2014 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

California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 46 POLST Resources  Consumer Brochure  FAQs

California POLST Education Program ©August 2014 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 

California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California HealthCare Foundation 48 Questions?