POLST POLST
New Documentation for Patients & Quality Care
ILLINOIS’ S IDPH UNIFORM DNR ADVANCE DIRECTIVE
•Illinois is changing the current IDPH DNR tomeet the national POLST standards used inother states
•POLST stands for “Physician Orders for Life-Sustaining Treatment”
•POLST reduces medical errors by improvingguidance during life-threatening emergencies
IDPH DNR …can also be called POLST nowIDPH DNR …can also be called POLST now
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Who is POLST Designed For?Who is POLST Designed For?
Focusing on patients as partners in their care.
The POLST form is designed for:
Patients facing life-threatening complications, regardless of age;and/or
Patients with advanced frailty and limited life expectancy; and/or
Patients who may lose the capacity to make their own health caredecisions in the next year (such as persons with dementia); and/or
Persons with strong preferences about current or anticipated end-of-life care.
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FIRST STEPS:
Complete a PoA. Thinkabout wishes if faced withsevere trauma and/orneurological injury.
NEXT STEPS:
Consider if, or how, goalsof care would change ifinterventions resulted inbad outcomes or severecomplications.
LAST STEPS:
End-of-Life plans -establish a specific plan ofcare using POLST to guideemergency medicalorders based on goals.
Maintain and Maximize Health, Choices, and IndependenceMaintain and Maximize Health, Choices, and Independence
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Document on Power of Attorney form
Document on POLST form
The POLST Form in IllinoisThe POLST Form in Illinois
The POLST DocumentThe POLST Document
•3 Primary Medical Order Sections
A.CPR for Full Arrest
•Yes, Attempt CPR
•No, Do Not Attempt CPR (DNR)
B.Orders for Pre-Arrest Emergency
•Full Treatment
•Limited Treatment
•Comfort Only
C.Artificial Nutrition and Hydration
•None
•Trial period
•Acceptable
NEW
NEW
The POLST DocumentThe POLST Document
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NEW
Section “A”: Cardio-Pulmonary ResuscitationSection “A”: Cardio-Pulmonary Resuscitation
•There are multiple kinds of emergencies. This section only addresses a fullarrest event (no breathing or pulse), and answers “Do we do CPR or not?”
•NEW! Patients can use this form to say YES to CPR, as well as to refuse CPR.
•The next section (“B”) addresses other emergencies where the patient is stillbreathing or still has a pulse.
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Code Status – applies when breathing AND pulse have stopped
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Section “B”: Medical InterventionsSection “B”: Medical Interventions
•Three categories explaining the intensity of treatment when the patient hasrequested DNR for full arrest, but is still breathing or has a pulse.
•Comfort – patient prefers symptom management and no transfer if possible
•Limited – no aggressive treatments such as intubation or mechanicalventilation, but other treatments are OK as expressed on the form
•Full – all indicated treatments including Intubation and MechanicalVentilation are acceptable
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Do Not Resuscitate does NOT mean Do Nothing
Section “B”: Medical InterventionsSection “B”: Medical Interventions
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•Use “Additional Orders” for other treatments that might come into question(such as dialysis, surgery, chemotherapy, blood products, etc.), especially if“Limited Additional Interventions” is selected.
•An indication that a patient is willing to accept full treatment should not beinterpreted as forcing health care providers to offer or provide treatment thatwill not provide a reasonable clinical benefit to the patient (would be “futile”).
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Section “A” choices influence medicalinterventions in Section “B”Section “A” choices influence medicalinterventions in Section “B”
Yes! Do CPRYes! Do CPR
Comfort MeasuresComfort Measures
Limited InterventionsLimited Interventions
DNR: No CPRDNR: No CPR
Full TreatmentFull Treatment
or
or
*
*
*Requires documentation of a “qualifying condition” ONLY when requested by a Surrogate.
Full TreatmentFull Treatment
Section A
Section B
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Section “C”: Artificially Administered NutritionSection “C”: Artificially Administered Nutrition
•Nutrition by tube can include temporary NG tubes, TPN, or permanentplacement feeding tubes such as PEG or J-tubes.
•A trial period may be appropriate when the benefits of tube feeding areunknown, or when the patient is undergoing other types of treatment wherenutritional support would be helpful.
•Depending on the length of the trial period, providers may want to considerusing less invasive forms of tube feeding before deciding on permanentplacement options.
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Requirements for a Valid FormRequirements for a Valid Form
•Patient name
•Resuscitation orders (Section “A”)
•Patient or Legal Representative signature
•Witness signature
•Provider name, signature and date
•All other information is optional
•Verbal orders signed by an RN are acceptable
•Photocopies and faxes ARE acceptable.
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Who Can Assist inPreparing a POLST Form?Who Can Assist inPreparing a POLST Form?
Healthcare providers – “licensed, certified, or otherwiseauthorized to provide healthcare in the normal course ofbusiness.”
Best practice suggests use of those trained in thePOLST Conversation such as (among others):
–Physicians
–Nurses
–Social Workers
–Care Managers
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Take-a-waysTake-a-ways
Begins now
Old DNR will still be accepted. Patients will be asked to fill out newform. So, old and POLST DNR will co-exist.
NCH policy on who witnesses POLST forms remain the same as withthe current DNR forms. Witnessing the document means one iswitnessing the signature
DNR policy continues just with a different form
If a patient wants medical intervention but is not sure what choices tomake, encourage conversation with physician
DNR form or POLST is not the same as Advance Directives
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Resources
Ethics site on NCH Intranet
National POLST site – www.polst.org
Chicago End-of-Life Care Coalition – www.cecc.info/
NCH Questions:
Spiritual Care Ext. 2010
Gloria Reidinger, Director of Healthcare Ethics @ x7970
Kathy Ferket, Executive Director Patient Care Support @ x7943
Claudette Johnson, Manager of Nursing Support @ x4241
This presentation for the POLST Illinois Taskforce has been made possible by in-kind and otherresources provided by POLST Illinois