POLST Physician Orders for Life Sustaining Treatment Adrienne Mims, MD Georgia POLST Collaborative Member

► Th e Role of POLST in Advance Care Planning ► How and when to use the POLST forms POLST

Advance Care Planning Discussion Decision Documentation

End-of-Life Principles End-Of-Life Care Is About: ► Compassion at the bedside ► Providing comfort ► Honoring patients’ preferences

Advance Care Planning ► A Discussion With Loved Ones ► Advance Directive - Living Will and Durable Power of Attorney ► POLST - Physician Order for Life Sustaining Treatment ► A Discussion With Loved Ones

POLST ► An order that makes a patient’s end of life wishes actionable ► Five sections ―Cardiopulmonary Resuscitation ―Medical Interventions ―Antibiotics ―Artificially Administered Nutrition ―Signatures (2) ► The POLST – transferred between different settings

Legal Foundations ► Advance Directive – Ga. AD Law HB 24 – Ga. Dept. Of Human Resources 2007 HB 24 Rules And Regulations ► Ga. DNR/AND & Cardiopulmonary Resuscitation Laws ► Physician Order For Life Sustaining Treatment (POLST) – Ga. DPH, POLST Form, 2012 – Ga. Code (l)

When to use POLST When, in the judgment of the physician, one of “Three Conditions” is met ► A patient is in a terminal condition ► A patient is in a permanent state of unconsciousness ► In medical judgment CPR would be futile

Admission to a Health Care Facility To identify or determine: ► Health Care Advocate’s name ► Patient’s medical state ► Code status based on ― Patients wishes ― Presence of the “Three Conditions ”

Health Care Team Responsibilities: ► To follow the patient’s known preferences ► To honor the patient’s Advance Directive and POLST without regard to personal views ► If unable to honor preferences, facilitate the transfer of patient’s care

LTC Implementation Case 1 – patient competent – complete advance directives (AD), complete POLST – MD and patient signs Case 2 – patient NOT competent – previously completed AD, complete POLST – MD and designee signs Case 3 – patient NOT competent – no prior AD – POLST from hospital is signature #1, LTC MD is signature #2 written in the chart

‘Getting it Right’ ► Honor all patients wishes ► Encourage all patients to have an Advance Care Plan ► Utilize POLST when patient condition applies ► Apply reasonable medical judgment

Conversation Project ► Veteran Boston journalist Ellen Goodman ► Launched in August 2012 ► Backing from the Institute for Healthcare Improvement

Georgia POLST Collaborative ► 20+ statewide organizations ► Part of an national movement to promote POLST ► Vision: All Georgians will have their health care preferences known and honored

Spring POLST Collaborative Conference Date: May 6, 2013 Location : Westin Peachtree Buckhead Time: 10 a.m. – 4 p.m. Keynote: Patricia Bomba, MD New York MOLST

Questions This material was shared by the POLST Georgia Collaborative and prepared by Alliant GMCF, the Medicare Quality Improvement Organization for Georgia, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. 10SOW- GA-IIPC-13-05