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A Potential Better Way to Ensure End-of-Life Care through Improved Medical Orders (POLST)
Ernest H. Rosenbaum, MD
A program developed at the Oregon Health Science University Hospital (OHSU) for patients requesting limited palliative care has been developed and is currently available in approximately fifteen states. It involves improved communication to respect a patient's wishes. Dr. Tolle and other health care associates discussed an article in the American College of Physicians Observer, July/August 2007 pg. 1, concerning a new standardized form called Physician's Orders for Life-Sustaining Treatments (POLST), which better conveys a dying patients wishes for all health care problems. This bright pink form signed by a physician, nurse or physician's assistant asks patients about preferences for CPR, antibiotics, artificially administered nutrition and general medical interventions. It is not designated for the healthy but for those with advanced, chronic illnesses, and it is actually a medical order.
If a patient is picked up by an emergency rescue squad, an Advanced Directive has to be interpreted and is not a medical order. Often, this is not a practical approach during an emergency situation, as there's not time to decipher what is often found in an Advanced Directive. Medical orders can be followed immediately. This also applies to the emergency medical technicians (EMT) team, hospital emergency rooms and is also the standard of care for nursing homes and hospices that are participating in certain states. This form can stay with the patient to be used at any time an emergency exists. It has been widely adopted in Oregon and saves unnecessary resuscitations when that was not the wish of the patients.
On the form, one selects choices of feeding tubes, antibiotics, or DNR. If the form has not been signed by a physician on admission or preadmission, it can be done if the patient is transferred to a nursing home or hospice.
The forms sometimes need to be adapted to state laws, such as in West Virginia, where state legislation was legalized to mandate use of the forms. Some places also use a bracelet to identify that a POLST form has been signed.
More information can be obtained from the Web site, www.polst.org. A project is currently in progress to help EMTs be able to call in to a central station to find out if the form has been signed.
This will help raise the awareness through POLSTs among the medical profession, general public and politicians, so the forms can be better used.
- This includes information on:
- Complete medical records
Insurance policies for life and disability
Benefits - Social Security, Veteran's benefits
End-of-life records, including wills, legacy of love papers, DNR, and documents on end-of-life care
The doctor, hospital and family members should have end-of-life documents, including wills, family records, and your wishes on end-of-life care.
Important information about your bank, lawyer, household obligations (utilities, telephone), and financial records of assets, mortgages, and other necessary forms should be included.
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