Physician Orders for Life-Sustaining Treatment (POLST)
February 21, 2013
Without a conversation about a person’s preferences for medical interventions, and a way to document them, patients can end up on a runaway medical train, undergoing ineffective, unwanted, painful, and expensive treatments while their psychological, emotional, and spiritual needs are poorly addressed.
To help patients have their say if they are unable to speak, CHCF has supported the use of Physician Orders for Life-Sustaining Treatment (POLST). POLST is a standardized medical order form that indicates the specific types of life-sustaining treatment a seriously ill patient does or does not want.
In the video below, the POLST form is discussed by Sister Martin de Porres Coleman, resident and care coordinator at Mercy Retirement and Care Center in Oakland, California.
What makes POLST powerful is that, unlike a health care directive, it is signed by the patient and physician and becomes a set of medical orders. And unlike a directive, the POLST form moves with the patient as part of the medical record. When used with an advance directive that names a proxy decisionmaker, POLST can reduce unwanted or ineffective care, reduce patient and family suffering, and ensure that patients’ wishes are honored.
Currently, 47 states have implemented POLST or are developing similar programs. A California law in effect since 2009 requires that POLST be honored in all care settings and gives immunity to providers who honor a POLST document in good faith.
Since August 2007, CHCF has supported POLST adoption by:
Promoting awareness through a communications strategy and a stakeholder task force
Creating a standardized approach to implementation with hands-on education and uniform materials
The Coalition for Compassionate Care of California provides leadership and oversight of these activities. The coalition supports local groups to promote adoption of POLST by hospitals, skilled nursing facilities, emergency medical services, and home health care agencies.