POLST Across the Continuum

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POLST Across the Continuum

• Practical Implementation
• Moderator Jeffrey Yee, MD
• Jay Goldman, MD - Ambulance Services/EMS for
  Kaiser Permanente
• Heather Harrison - California Assisted Living
  Association
• Gwendolyn Kaltoft, RN, EdD - Yolo Hospice
• Catherine Russell-McGregor, RN, MSN, FNS,C -
  Sutter Health
• Kerri Stuart, RN, BSN, CHPN - UC Davis Cancer
  Center

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POLST Collaboration

• Creating the POLST form
• Informed, collaborative choices
• May originate in a variety of settings
• Guide for treatment decisions
• Coordinated treatment
• Maintain consistent goals wherever treatment is
  delivered

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POLST COMMUNITY PLAN OF CARE
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COMPLETING POLST
Verify choices agree with patient values and
are medically coherent
Identify POLST Candidate
Provide education regarding treatment choices
and prognosis
Complete POLST and obtain signature
Maintain POLST Accessible Periodic
Review Update
Align facility care plan and orders
Physician signature
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POLST IN ACTION
Evaluate Patient and POLST plan of care
Identify POLST situation
Transfer as indicated handoff POLST
Assess need for higher level of evaluation and/or
treatment
Onsite treatment or comfort plan
TREATMENT POLST aligned or Temporary
suspension by agreement
Patient and POLST Handoff
DISCHARGE PLANNING Review POLST and reinstate
or revise
Transport patient with POLST