POLST
Community
Presentation
Physician
Orders for
Life
Sustaining
Treatment
California POLST Education Program
©August 2014 Coalition for Compassionate Care of California
Materials made possible by a grant from the California HealthCare Foundation
1
POLST

What is POLST and why is it important?

Overview of the POLST form

How do I complete a POLST?
California POLST Education Program
©August 2014 Coalition for Compassionate Care of California
Materials made possible by a grant from the California HealthCare Foundation
2
Why POLST?


Patient wishes often are not known.
–
The Advance Healthcare Directive (AHCD)
may not be accessible.
–
Wishes may not be clearly defined in AHCD.
–
The AHCD is not a physician order.
Allows healthcare professionals to know
and honor your wishes for care.
California POLST Education Program
©August 2014 Coalition for Compassionate Care of California
Materials made possible by a grant from the California HealthCare Foundation
3
POLST Conversations

Focus is on the conversation.

It is important to talk about and document
your wishes before you become seriously
ill.
California POLST Education Program
©August 2014 Coalition for Compassionate Care of California
Materials made possible by a grant from the California HealthCare Foundation
4
Case Study: What We Know
California POLST Education Program
©August 2014 Coalition for Compassionate Care of California
Materials made possible by a grant from the California HealthCare Foundation
5
Case Study: What We Didn’t Know
California POLST Education Program
©August 2014 Coalition for Compassionate Care of California
Materials made possible by a grant from the California HealthCare Foundation
6
Case Study: What Happened

AHCD not transferred with patient.

DNR wishes not documented.

Over-treatment against patient wishes.

Unnecessary pain and suffering.
California POLST Education Program
©August 2014 Coalition for Compassionate Care of California
Materials made possible by a grant from the California HealthCare Foundation
7
What is POLST?

A physician order recognized throughout the
medical system.

Portable document that transfers with the
patient.

Brightly colored, standardized form for entire
state of CA.
California POLST Education Program
©August 2014 Coalition for Compassionate Care of California
Materials made possible by a grant from the California HealthCare Foundation
8
What is POLST?

Allows individuals to choose medical treatments
they want to receive, and identify those they do
not want.

Provides direction for healthcare providers during
serious illness.
California POLST Education Program
©August 2014 Coalition for Compassionate Care of California
Materials made possible by a grant from the California HealthCare Foundation
9
Who Would Benefit from Having a
POLST Form?

Chronic, progressive illness

Serious health condition

Medically frail
California POLST Education Program
©August 2014 Coalition for Compassionate Care of California
Materials made possible by a grant from the California HealthCare Foundation
11
POLST History

POLST development began in Oregon in 1991.

Expanded to more than half of the United
States.

Studies have shown that POLST is effective in
providing care that is consistent with patient
wishes.
California POLST Education Program
©August 2014 Coalition for Compassionate Care of California
Materials made possible by a grant from the California HealthCare Foundation
12
National POLST Paradigm Programs
www.polst.org
*As of January 2014
Mature Programs
Endorsed Programs
Regionally Endorsed Program
Developing Programs
No Program (Contacts)
Programs That Do Not Conform to
POLST Requirements
POLST Success
Oregon Study: Location of Death and POLST Orders
•
58,000 deaths reviewed, 31% had POLST in Oregon Registry
•
Patient treatment choices honored, including avoiding dying in hospital
Full Treatment
1,153
Hospital Death
44.2%
Out Hospital Death
55.8%
Comfort Measures Only
11,836
Limited Interventions
4,787
Hospital Death
22.4%
Out Hospital Death
77.6%
Fromme EK, JAGS 2014
California POLST Education Program
©August 2014 Coalition for Compassionate Care of California
Materials made possible by a grant from the California HealthCare Foundation
14
Hospital Death
6.4%
Out Hospital
Death 93.6%
POLST in California

The Coalition for Compassionate Care of
California (CCCC) is lead agency.

Support from California HealthCare Foundation.

Grassroots efforts of local POLST coalitions and
communities.
California POLST Education Program
©August 2014 Coalition for Compassionate Care of California
Materials made possible by a grant from the California HealthCare Foundation
15
POLST in California
Effective January 1, 2009
California POLST Education Program
©August 2014 Coalition for Compassionate Care of California
Materials made possible by a grant from the California HealthCare Foundation
16
POLST in California

One form for entire state.

Use not mandated.

Honoring form is mandated.
AB 3000, Wolk. Part 4, Sec 7, Probate Code Section 4782
California POLST Education Program
©August 2014 Coalition for Compassionate Care of California
Materials made possible by a grant from the California HealthCare Foundation
17
POLST vs.
Advance Healthcare Directive



POLST complements the Advance Healthcare
Directive (AHCD).
POLST is not intended to replace the AHCD.
Both are legal documents.
AB 3000, Part 4, Sec 3, Probate Code 4780 (3) (c)
California POLST Education Program
©August 2014 Coalition for Compassionate Care of California
Materials made possible by a grant from the California HealthCare Foundation
18
POLST vs.
Advance Healthcare Directive
POLST
AHCD


For seriously ill/frail,
at any age
 Physician orders for
medical treatment
For anyone 18 and
older
 General instructions
for treatment
 Appoints
decisionmaker
California POLST Education Program
©August 2014 Coalition for Compassionate Care of California
Materials made possible by a grant from the California HealthCare Foundation
19
Where Does POLST Fit In?
Advance Care Planning Continuum
Age 18
Complete an Advance Directive
Update Advance Directive Periodically
Diagnosed with Serious or Chronic,
Progressive Illness (at any age)
Complete a POLST Form
Treatment Wishes Honored
California POLST Education Program
©August 2014 Coalition for Compassionate Care of California
Materials made possible by a grant from the California HealthCare Foundation
20
POLST vs. Pre-Hospital DNR
(Do Not Resuscitate)

Similarities:
–
–
–
Physician orders.
Address Do Not Resuscitate.
Intended for medically frail or those with
chronic or serious illness.
California POLST Education Program
©August 2014 Coalition for Compassionate Care of California
Materials made possible by a grant from the California HealthCare Foundation
21
POLST vs. Pre-Hospital DNR
(Do Not Resuscitate)
POLST
Pre-Hospital DNR


Allows for choosing
resuscitation
 Allows for other
medical treatments
 Honored across all
healthcare settings
Can only use if
choosing DNR
 Only applies to
resuscitation
 Only honored outside
the hospital
California POLST Education Program
©August 2014 Coalition for Compassionate Care of California
Materials made possible by a grant from the California HealthCare Foundation
22
How Do I Complete a POLST?

Talk to your doctor about what kind of
medical treatment you would want if you
became seriously ill.

Talk to your doctor about POLST.

Talk to your family about your decisions.
California POLST Education Program
©August 2014 Coalition for Compassionate Care of California
Materials made possible by a grant from the California HealthCare Foundation
24
Where Do I Keep a POLST?
Original pink POLST stays with you!

At home:
–
–

Post in easy-to-find location (with AHCD).
Give to Emergency Medical Services.
At Hospital or Skilled Nursing Home:
–
–
File in medical chart (with AHCD).
Goes with you if you are transferred.
California POLST Education Program
©August 2014 Coalition for Compassionate Care of California
Materials made possible by a grant from the California HealthCare Foundation
25
Can POLST be Changed?

You can change your POLST at any time.

If you cannot speak for yourself, your
healthcare decisionmaker may request a
change based on a change in your
condition or new information about your
wishes.
California POLST Education Program
©August 2014 Coalition for Compassionate Care of California
Materials made possible by a grant from the California HealthCare Foundation
26
POLST

Talk with your doctor and your family

Visit www.caPOLST.org
California POLST Education Program
©August 2014 Coalition for Compassionate Care of California
Materials made possible by a grant from the California HealthCare Foundation
27
Questions?
California POLST Education Program
©August 2014 Coalition for Compassionate Care of California
Materials made possible by a grant from the California HealthCare Foundation
28