POLSTPhysician Orders for Life Sustaining Treatment

Adrienne Mims, MDGeorgia POLST Collaborative Member

► The Role of POLST in Advance Care Planning

► How and when to use the POLST forms

POLST

Advance Care Planning

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 - 2007 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 29-4-18 (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

www.theconversationproject.org

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, 2013Location : Westin Peachtree BuckheadTime: 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