POLST stands for Physician Orders for Life-Sustaining Treatment. The term "POLST Paradigm" is used to describe several programs, developed on a
state or community-wide basis, having different program names, forms, and
policies.
What is a POLST Paradigm form?
A POLST Paradigm form is a brightly colored, medical order form, used to
write orders indicating life-sustaining treatment wishes for seriously ill
patients. The form accomplishes two major purposes:
It turns treatment wishes of
an individual into actionable medical orders.
It is portable from one care
setting to another.
Why was POLST developed?
POLST was developed initially in response to seriously ill patients
receiving medical treatments that were not consistent with their wishes. The
goal of a POLST Paradigm Program is to honor patient's end-of-life treatment
preferences either to have or to limit treatment, even when transferred from
one care setting to another.
Who should have a POLST Paradigm
form?
A POLST Paradigm form is most appropriate for seriously ill persons with
life-limiting, also called terminal, illnesses or advanced frailty characterized
by significant weakness and extreme difficulty with personal care activities.
How does a POLST Paradigm form work?
The POLST Paradigm form remains with a patient if he/she is moved between
care settings, regardless of whether the patient is in the hospital, at home,
or in a nursing home. If you live at home, keep the original POLST Paradigm
form where community emergency responders will look for it (most programs
recommend the side or front of the refrigerator). If you live in a nursing or
adult foster care home, the POLST Paradigm form will be kept in your chart.
How does a patient get a POLST
Paradigm form?
POLST Paradigm Programs are available in Oregon. A patient can start by speaking to his/her
primary care professional about communicating their goals of care and whether
POLST is right for them.
Does a patient have to have a POLST
Paradigm form?
No. The use of a POLST Paradigm form is always voluntary.
Does a POLST Paradigm form replace
traditionalAdvance Directives?
No. Traditional Advance Directives are recommended for all adults. Advance
directives allow you to express your wishes and appoint someone you would like
to make health care decisions if you are not able to do so. When available, an
Advance Directive should accompany a POLST Paradigm form but is not required
for the orders to be valid.
Who completes the POLST Paradigm
form?
A health care professional (usually a physician, nurse practitioner,
physician assistant or social worker) completes the form after understanding
the patient's values and goals of care. Remember, a POLST Paradigm form is a
medical order and is therefore not completed by the patient.
Who signs a POLST Paradigm form?
The form must be signed by a physician, and in some states it may also be
signed by a nurse practitioner (NP) or physician assistant (PA), to be valid.
Many states also require the patient or his/her chosen decision-maker's
signature.
What if the patient's POLST
Paradigm form does not have the signature of his/her doctor (nurse
practitioner, or physician assistant)?
The form is not considered valid without the signature of a physician, or in
some states a nurse practitioner (NP) or physician assistant (PA).
What happens after the form is
complete?
The original POLST Paradigm form always remains with the patient. In a
health care facility, the form will be in the medical record. In a home setting
the form should be placed in a location recognized by emergency medical
personnel (usually the side or front of the refrigerator). Health care
facilities will make a copy of the form for your medical record before sending
you home or to a different care setting.
What if the patient's loved one can
no longer communicate her/his wishes for care?
Family members may be able to speak on behalf of a loved one. A health care professional
can complete the POLST Paradigm form based on family members' understanding of
their loved one's wishes. Some state laws have limitations on the power of a
patient's chosen decision-maker so check with your health care professional.
Do any POLST Paradigm Programs
require POLST bylaw?
No. The POLST Paradigm form is always voluntary and is intended to:
Help patients and health care
professional discuss and develop plans to reflect treatment wishes.
Assist physicians, nurses,
health care facilities, and emergency personnel to know and honor a
patient's preferences for life-sustaining treatment.
What
are some of the medical terms used when talking about serious illness?
Advance Directives:
Advance directives are written instructions stating how you wish your
medical decisions be made if you become unable to make decisions for
yourself. Some advance directives are sometimes called living wills. Most
states allow patients to appoint a person who can make health care
decisions on their behalf when patients cannot speak for themselves.
Antibiotics:
Antibiotics treat some infections (such as pneumonia) that can develop
when a person is seriously ill. Antibiotics may also treat symptoms (such
as with a bladder infection.)
Artificial nutrition:
When a person can no longer eat or drink by mouth, liquid food can be
given to them by tube.
Cardiopulmonary
resuscitation (CPR): Attempts to restart breathing and the
heartbeat of a person who has no heartbeat or has stopped breathing.
Typically involves "mouth-to-mouth" and forceful pressure on the
chest to restart the heart. May also involve electric shock
(defibrillation) or a plastic tube down the throat into the windpipe to
assist breathing (intubation).
Comfort measures:
Care undertaken with the primary goal of keeping a person comfortable
(rather than prolonging life). On the POLST Paradigm form, a person who
requests "comfort measures only" would be transferred to the
hospital only if needed for his or her comfort.
Intravenous (IV)
fluids: A small plastic tube (catheter) is inserted directly into
the vein and fluids are administered through the tube. Typically, IV
fluids are given on a short-term basis.
Mechanical
ventilation/respiration: A plastic tube is put down the throat to
help breathing intubation. A machine pumps air in and out of the lungs
through the tube when a person is no longer able to breathe on his/her
own.
Tube feeding:
On a short-term basis, fluids and liquid nutrients can be given through a
tube in the nose that goes into the stomach (nasogastric or "NG"
tube). For long-term feeding, a tube can be inserted though a surgical
procedure directly into the stomach (gastric or "G" tube) or the
intestines (jejunal or "J" tube).
Medical
decision-maker: If you are unable to make decisions for yourself,
most state laws allow a family member to serve as your representative and
make decisions for you. If you have completed a medical power of attorney
or health care proxy, the person designated on that form will be your
legal health care representative.
