POLST Community Presentation

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POLST Community Presentation

• Physician
• Orders for
• Life
• Sustaining
• Treatment

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POLST

• What is POLST and why is it important?
• Brief overview of the POLST form
• How do I complete a POLST?

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Why POLST?

• Patient wishes are often not known. Advance
  Health Care Directive (AHCD) may not be
  accessible or honored.
• POLST allows healthcare professionals to know
  your wishes for care and honor them.

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California POLST Form

• Focus is on the conversation.
• It is important to talk about and document your
  wishes before you become seriously ill.

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Case StudyWhat We Know

• Mr. Jones, an 83 year old man with severe
  emphysema and some memory loss.
• In a Skilled Nursing Facility (SNF) after
  hospital stay for pneumonia.
• Developed shortness of breath and was less
  responsive (could not clearly talk to staff).
• SNF staff called Emergency Medical System who
  transported him to hospital.

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Case StudyWhat We Know

• Emergency Department doctor could not find any
  code status information in Mr. Jones paperwork.
• Doctors order written, Attempt CPR.
• Mr. Jones breathing became very weak he was
  intubated, placed on ventilator and transferred
  to the Intensive Care Unit.

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Case StudyWhat We Didnt Know

• Mr. Jones had an AHCD. It was at his home, so the
  SNF could not send it to the hospital.
• Mr. Jones had talked with his family about his
  desire not to be on a ventilator again.
• The Emergency Doctor did not know.
• The weekend nurses at the SNF could not reach his
  family and did not know about his wishes.

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Case StudyWhat Went Wrong

• AHCD was not sent with patient.
• Mr. Jones wishes were not known or honored.
• Treatment was given that he did not want.
• Unnecessary pain and suffering.

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What is POLST?

• A physician order recognized by the entire
  medical system.
• A portable document that goes with the patient.
• Provides direction for a range of medical
  treatments.
• Brightly colored, consistent form for entire
  state of California.

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Who Needs POLST?

• Chronic, progressive illness
• Serious health condition
• Medically frail

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POLST History

• POLST development began in Oregon in 1991.
• Use of POLST now expanded to more than 23 states.
• Studies have shown that POLST is effective in
  providing care that is consistent with patient
  wishes.

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POLST in California

• POLST is being implemented in California.
• CA Assembly Bill 3000 recognizes POLST as a legal
  document.
• A single form for the entire state.
• Use of POLST is not mandated.
• Honoring POLST is mandated.

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Does POLST Replace the Advance Health Care
Directive?

• POLST does not replace the Advance Health Care
  Directive (AHCD).
• AHCD allows you to name a health care
  decisionmaker if in the future you are unable to
  communicate your wishes.
• Everyone 18 years and older is encouraged to
  complete an AHCD.

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POLST vs. Pre-Hospital DNR (Do Not Resuscitate)

• POLST and Pre-Hospital DNR
• Address Do Not Resuscitate
• POLST
• Allows for choosing resuscitation
• Discusses other life-sustaining treatments
• Honored across all healthcare settings
• Pre-Hospital DNR
• Honored outside hospital only (home, assisted
  living, Emergency Medical Services system)

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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.

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Where Do I Keep a POLST?

• Original pink POLST stays with you.
• Keep in easy-to-find location in your home (on
  refrigerator or hanging on wall in bedroom)
• Copy of POLST is filed in your medical chart.
• Keep a copy of your AHCD with POLST (in plastic
  cover).

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Can POLST Be Changed?

• You can change your POLST at any time.
• If you cannot speak for yourself, your health
  care decisionmaker may request a change to POLST
  based on a change in your condition .

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POLST

• Talk with your doctor and your family
• Visit www.capolst.org
•