Indiana Physician Orders for
Scope of Treatment (IN POST)
Sonya M. Zeller, MBA, MSN, RN
September 11, 2013
IN POST Form
• IN POST = Indiana’s Physician Orders for Scope of
Treatment
• Law—July 1, 2013
• New advanced care planning
• End-of-life treatment preferences—last 12 months
• Patient/Surrogate and Physician signatures
required—Official Physician Order
• Transfers across all settings
IN POST Form
Source: www.in.gov/isdh/25880.htm
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IN POST Form
• Standardized Order Form—found on the Indiana State
Department of Health website at
http://www.in.gov/isdh/25880.htm
• Purpose of IN POST Form…better identification and respect
of patients’ preferences for treatment at end-of-life
• CPR-code or no code status
• Level of medical intervention
– comfort measures stipulates no transfer to hospital for
life-sustaining treatment, transfer only if needs cannot
be met at current location
– use of antibiotics (for comfort only or full treatment)
– use of medically administered nutrition
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IN POST Form Criteria
• Criteria for IN POST Form: must have one or more
of the following conditions:
– Advanced chronic progressive illness
– Advanced chronic progressive frailty
•Note: Frailty is a medical diagnosis
– A terminal condition
– Unlikely to benefit from CPR
• Question to ask: Would the patient’s physician be
surprised if the patient died within the next 12
months?
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IN POST Form Conversations
• IN POST Form can be filled out based on a
conversation regarding patient end-of-life care
preferences
• Surrogate decisions must be based on prior known
wishes or best interest of patient
• Conversation regarding the IN POST Form can be
initiated by anyone
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Types of Advance Directives in IN
• Talking directly with physician and family
• Organ and tissue donation
• Health care representative
• Living Will Declaration or Life-Prolonging
Procedures Declaration
• Psychiatric advance directives
• Out of Hospital Do Not Resuscitate Declaration and
Order
• Physician Orders for Scope of Treatment (POST)
Source: www.in.gov/isdh/files/advanceddirectives.pdf
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IN POST Legal Protection
• The IN POST Act provides legal protection for
health care providers who comply with the orders
on IN POST forms
• In the law, health care providers are not subject to
civil or criminal liability for good faith compliance
with or reliance upon IN POST Forms
Source: www.iupui.edu/~irespect/POST.html
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POLST and IN POST
• Dark pink = endorsed
• Light pink = developing
• White = no activity
Source: www.polst.org
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IN POST Evidence-Based
• POST supports patient-centered care by expanding beyond
DNR/full code orders (Hammes et al., 2012; Hickman et al.,
2004; 2009)
• POST is more effective than traditional approaches at ensuring
treatment preferences are documented as orders (Hickman et
al., 2010);
• POST orders do change the kinds of treatments patients receive
(Hickman et al., 2010);
• Treatments provided are largely consistent with POST orders
(Hickman et al., 2011);
• POST is viewed as helpful by clinicians including EMTs and
hospice personnel (Schmidt et al., 2004; Hickman et al., 2009)
Source: www.iupui.edu/~irespect/POST.html
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IN POST Supported
• Indiana Patient Preferences Coalition
– Mission: To develop a standardized tool to record patient
wishes as medical orders that transfer across treatment
settings with a goal of honoring individual preferences
for care.
• A coalition of 60 + professionals in health care,
ethics, law, and senior services committed to
honoring patient treatment preferences
• First formed in August 2010 to explore the
development of the Indiana version of the POLST
Paradigm
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IN POST Legislative History
• 2012 Session - HB 1114
– Did not make it out of committee
• 2013 Session - HB 1182
– Passed Indiana House 99-0
– Passed Indiana Senate 48-1 with amendments
– Concurrence passed with vote of 95-0
– Signed into law by Governor May 7, 2013
– Law Effective July 1, 2013
Source: www.iupui.edu/~irespect/POST.html
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IN POST Form and Conversation
• IN POST = Indiana’s Physician Orders for Scope of
Treatment
• Law—July 1, 2013
• New advanced care planning
• End-of-life treatment preferences—last 12 months
• Patient/Surrogate and Physician signatures
required—Official Physician Order
• Transfers across all settings
IN POST References
• Hickman, S. (2013). Overview of the Indiana POST.
Retrieved from
http://www.iupui.edu/~irespect/POST.html
• Indiana Department of Health. Advance Directives.
(2013). Retrieved from
http://www.in.gov/isdh/files/advanceddirectives.pdf
• Indiana University Purdue University Indianapolis.
(2013). Retrieved from
http://www.iupui.edu/~irespect/POST.html
• POLST. (2012). Retrieved from http://www.polst.org
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