POLST: Respecting Patient Wishes Near the End of Life - PowerPoint PPT Presentation

1 / 39
About This Presentation
Title:

POLST: Respecting Patient Wishes Near the End of Life

Description:

These are the Oregon statures. Oregon s EMT scope of practice includes language that requires EMTs to honor POLST and to look for it States will vary POLST is a ... – PowerPoint PPT presentation

Number of Views:130
Avg rating:3.0/5.0
Slides: 40
Provided by: TerriS77
Learn more at: https://www.polst.org
Category:

less

Transcript and Presenter's Notes

Title: POLST: Respecting Patient Wishes Near the End of Life


1
(No Transcript)
2
The POLST Registry Ethical Treatment in EMS Care
  • Terri Schmidt MD, MS

3
If I have cancer or something, resuscitation
is a waste of time, because you know youre going
to die.  I would like to be in a hospice
situation where there is someone to hold your
hand or make sure you are comfortable.
4
Definitions
  • Advance directives
  • Directive to physicians/living will
  • Power of attorney for health care
  • Do not attempt resuscitation-DNAR
  • POLST and POLST paradigm (In some states called

5
ADVANCE DIRECTIVE POLST
For whom For all adults  For persons of any age with advanced illness
Purpose To express values and appoint a surrogate (future wishes) Medical orders which turn a patients values into action (applies today)
Guide actions by Emergency Medical Personnel Usually not Yes
Guide treatment decisions in the hospital Yes Yes
6
What Is POLST
  • A health care providers order
  • Can be completed by others (SW, RN) but must be
    signed by MD, DO, NP or PA
  • May be a verbal order from one of the above,
    signed by an RN
  • Consistent recognized document

7
Development of POLST
  • Consensus development
  • Began in 1991
  • Newest revision June 2011
  • Voluntary process in Oregon, legislated in some
    other states including Washington
  • Now used or developing in more than 30 states
  • National POLST Advisory panel

8
Elements of the POLST Paradigm
  • Medical order form
  • Accompanies patient
  • Bright, unique color (Pink in OR, green in WA)
  • Training of professionals
  • DNAR orders
  • Limit or provide other interventions
  • Decisions about transport, ICU, artificial
    nutrition

9
National POLST Development
10
(No Transcript)
11
If I am unconscious at the last moment then I
dont want any machines or anything.
12
Oregon Administrative Rules
  • EMT Scope of Practice OAR 847-35-0030(6).
  • The Oregon Medical Board has defined the Scope of
    Practice so that an Oregon-certified First
    Responder or EMT shall comply with
    life-sustaining treatment orders executed by a
    physician, physician assistant or nurse
    practitioner
  • Oregon Medical Board OAR 847-010-0110
  • The fact that a physician, physician assistant or
    nurse practitioner who executed a life-sustaining
    treatment order does not have admitting
    privileges at a hospital or health care facility
    where the patient is being treated does not
    remove the obligation under this section to honor
    the order.

13
Requirements to Make the Form Valid
  • Patient name
  • Resuscitation orders
  • Provider signature and date
  • all other information is optionalin Oregon it
    does not require signature of patient
  • (verbal orders signed by an RN are acceptable)

14
Validation of POLST
  • Dunn PM, Schmidt TA et al A method to
    communicate patient preferences about medically
    indicated life sustaining treatment JAGS
    199644785
  • Tolle SW, Tilden VP, Nelson CA, Dunn PM A
    Prospective study of the efficacy of the POLST
    JAGS 1998461097
  • Lee MA, Brummel-Smith K et al Physician orders
    for life-sustaining treatment (POLST) Outcomes
    in a PACE program JAGS 2000 481-6.

15
  • Schmidt TA, Hickman SE, Tolle SW, Brooks HSThe
    Physician Orders for Life-Sustaining Treatment
    Program Oregon Emergency Medical Technicians
    Practical Experience and Attitudes JAGS
    2004521430-34.
  • Hickman SE, Tolle SW, Brummel-Smith K, Carley MM
    Use of POLST (The Physician Orders for
    Life-Sustaining Treatment Program) in Oregon
    Nursing Facilities JAGS 2004521424-2
  • Hickman SE, Nelson CA, Perrin NA, Moss AH, Hammes
    BJ, Tolle S A comparison of methods tp
    communicate treatment preferences in nursing
    facilities Traditional practices versus the
    physician orders for life-sustaining treatment
    program JAGS 2010 Jul58(7)1241-8.

16
(No Transcript)
17
Section A Cardiopulmonary Resuscitation (CPR)
18
  Section B Medical Interventions
11/4/2013
19
Section C Artificially Administered Nutrition
11/4/2013
20
Section D DOCUMENTATION OF DISCUSSION
11/4/2013
21
Section E Signature of Physician / NP/ PA
11/4/2013
22
  • Schmidt TA, Hickman SE, Tolle SW, Brooks HS The
    Physician Orders for Life-Sustaining Treatment
    Program Oregon Emergency Medical Technicians
    Practical Experience and Attitudes JAGS
    2004521430-34

23
Methods
  • Anonymous survey mailed in 2002 to a stratified
    random sample of Oregon paramedics and
    EMT-Intermediates

24
Findings
  • 572/1048 (55) response rate
  • 76 male
  • 66 paramedics

25
  • 73 had treated a patient with a POLST
  • POLST, when present, changed treatment in 45 of
    patients

26
  • 75 thought POLST provided clear instructions
    about patient preferences
  • 93 thought POLST useful in determining treatment
    when patient in cardiopulmonary arrest
  • 63 thought it useful in other circumstances

27
  • 25 reported some difficulty finding the form
  • 87 were filled out appropriately
  • 6 had conflicting orders
  • 5 unsigned
  • 2 incomplete

28
  • It was not followed in 37 (10) cases
  • 17 changed by family or other care giver on scene
  • 9 changed by patient
  • 8 changed by physician/EMT/hospital

29
Case Study When POLST Works
30
Where to keep the POLST
  • The front of the chart
  • In a red envelop on the fridge (but people do not
    like it)

31
The Oregon POLST Registry
  • For Emergency Medical Services, emergency
    departments and hospital acute care units

32
What is it?
  • Secure electronic registry of POLST orders.
  • Located at the Emergency Communication Center at
    OHSU and protected by the OHSU firewall
  • Allows health care professionals access to POLST
    orders if the original POLST form cannot be
    immediately located.

33
How did it happen?
  • Piloted the concept at the county level
  • HIPAA concerns made registry difficult
  • State law created requiring reporting of POLST
    forms made creation possible
  • Mandate supported by stakeholders
  • Division of duties
  • State- funds the registry
  • Center for Ethics responsible for education and
    forms

34
(No Transcript)
35
(No Transcript)
36
(No Transcript)
37
(No Transcript)
38
Current calls as of November 30, 2011
  • 920 calls
  • 270 matches
  • 30.1 match rate

39
(No Transcript)
40
(No Transcript)
41
How do I access the POLST Registry?
  • Call the 24 hour POLST Registry EMS line
  • Say, This is ______________ agency/emergency
    department, with an immediate POLST form request

Provide as much as possible of the following
patient information, to the Registry staff
  • Full name
  • Date of Birth
  • Gender
  • Last 4 SSN
  • POLST Registry ID
  • Home address/residential care facility address
  • City, County, or zip code

42
What information will be provided?
  • Section A and B orders, the date the form was
    signed, and the POLST Registry ID number.
  • Hospitals can be faxed the POLST form.
  • EMS Confirm your destination hospital and a copy
    can be sent ahead
  • THE STAFF ARE NOT MEDICAL PROVIDERS AND CANNOT
    INTERPRETPOLST ORDERS

43
Some examples
  • Case I EMS Case
  • Case 2 ED Case

44
My mother was choking. Called 9-1-1 because her
lips were blueput her on the floor and did CPR.
The medics came and took over. I told them she
had a POLST but I couldnt find itthe form used
to be on the fridge but we got a new one and
hadnt moved it there yet. I that day her
wishes were honored. Daughter of pt   The
daughter was the one who informed first
responders that the patient had a POLST form
which prompted us to call the RegistryAll
life-saving measures were terminated as soon as
orders were announced to honor end of life
wishesThe Registry is a good thing. It is a
stressful time for family and the ability to call
and get the wishes is really helpfulMedic on the
scene
45
The pt was very old and in cardiac arrest. There
was a language barrier at the scene and we were
trying to ask the daughter if he had a POLST.
Daughter came back with magnet. Without them the
family the POLST would have never been known to
existoverall, it call to the Registry was
successful. -Medic on the scene
46
The pt was very old and in cardiac arrest. There
was a language barrier at the scene and we were
trying to ask the daughter if he had a POLST.
Daughter came back with magnet. Without them the
family the POLST would have never been known to
existoverall, it call to the Registry was
successful. -Medic on the scene
47
We had dinner, he was holding the placemats,
and he just went down and collapsed. There was
no eye contact, no voice contact. I called 9-1-1
and my son and daughter-in-law came overasked if
they wanted to override the POLST and we decided
no. This is what he wanted. His wishes were
definitely honored. EMS was professional,
quick, and efficient... The Registry is a
wonderful idea. Should be more publicized so
people know where to put it POLST form -Wife
of pt
48
The Oregon POLST Registry
  • Emergency Communication Center at OHSU
  • 503 494-7333 (MRH)
  • 888 476 5787 (1-888 4-POLSTS)
  • E-mail polstreg_at_ohsu.edu
  • Website
  • http//www.ohsu.edu/polst/programs/OregonPOLSTRegi
    stry.htm

49
POLST Information
  • Center for Ethics in Health Care
  • 503 494-3965
  • Fax 503 494-1260
  • Ethics_at_ohsu.edu
  • www.polst.org

50
Thank you!
Write a Comment
User Comments (0)
About PowerShow.com