what is polst?
DESCRIPTION
What is POLST?. P hysician O rders for L ife S ustaining T reatment. Why POLST?. Patient wishes often are not known. The Advance Health Care Directive (AHCD) may not be accessible, clear, or honored. Allows healthcare professionals to know wishes for end-of-life care and honor them. - PowerPoint PPT PresentationTRANSCRIPT
What is POLST?
PhysicianOrders for LifeSustainingTreatment
California POLST Education Program© May 2009 California Coalition for Compassionate CareMaterials made possible by a grant from the California HealthCare Foundation
2
Why POLST?
1. Patient wishes often are not known. The Advance Health Care Directive (AHCD) may not be accessible, clear, or honored.
2. Allows healthcare professionals to know wishes for end-of-life care and honor them.
California POLST Education Program© May 2009 California Coalition for Compassionate CareMaterials made possible by a grant from the California HealthCare Foundation
3
Case Study: What We Know
Mr. Jones, an 83 year old man with severe chronic obstructive pulmonary disease (COPD) and mild dementia.
In skilled nursing facility (SNF) after hospital stay for pneumonia.
Developed increased shortness of breath and decreased responsiveness.
SNF called Emergency Medical System who transported patient to hospital.
California POLST Education Program© May 2009 California Coalition for Compassionate CareMaterials made possible by a grant from the California HealthCare Foundation
4
Case Study: What We Know
Emergency Room physician could not find any code status information in SNF papers.
Wrote “Full Code for now, status unclear.” Mr. Jones was intubated and transferred
to the ICU.
California POLST Education Program© May 2009 California Coalition for Compassionate CareMaterials made possible by a grant from the California HealthCare Foundation
5
Case Study: What We Didn’t Know
Mr. Jones had an AHCD. It was at his home so the SNF couldn’t send it to the hospital.
Mr. Jones had talked with his family and SNF staff about his desire not to go back to the hospital and receive aggressive treatment.
There was no documentation of the conversation to alert the ED staff.
The weekend nurses at the SNF could not reach his family and did not know about his wishes.
California POLST Education Program© May 2009 California Coalition for Compassionate CareMaterials made possible by a grant from the California HealthCare Foundation
6
Case Study: What Went Wrong
AHCD not transferred with patient. DNR wishes not documented. Over-treatment against patient wishes. Unnecessary pain and suffering. System-wide failure to document and
honor patient wishes.
California POLST Education Program© May 2009 California Coalition for Compassionate CareMaterials made possible by a grant from the California HealthCare Foundation
7
What is POLST?
A physician order recognized throughout the medical system.
Portable document that transfers with the patient.
Provides direction for a range of end-of-life medical treatments.
Brightly colored, standardized form for entire state of CA.
California POLST Education Program© May 2009 California Coalition for Compassionate CareMaterials made possible by a grant from the California HealthCare Foundation
8
Who Needs POLST?
Chronic, progressive illness Serious health condition Medically frail Tool for determination
• “You wouldn’t be surprised if this patient died within the next year.”
California POLST Education Program© May 2009 California Coalition for Compassionate CareMaterials made possible by a grant from the California HealthCare Foundation
9
POLST History
POLST development began in Oregon in 1991.
Initially for SNF patients transferred from one care setting to another.
Use of POLST now expanded to more than 23 states.
Oregon study of 180 SNF patients – POLST stated: No CPR and Comfort Measures Only. Patient wishes were honored.
Developing ProgramsDeveloping Programs*As of February 2009
National POLST Paradigm Initiative Programs
Established ProgramsEstablished Programs
No Program (Contacts)No Program (Contacts)Designation of POLST Paradigm Program status based on information available by the program to the Task Force.
California POLST Education Program© May 2009 California Coalition for Compassionate CareMaterials made possible by a grant from the California HealthCare Foundation
11
POLST in California
California Coalition for Compassionate Care (CCCC) is lead agency with support from California HealthCare Foundation
CA Assembly Bill 3000 Effective January 1, 2009 One form for entire state Use not mandated Honoring form is mandated
California POLST Education Program© May 2009 California Coalition for Compassionate CareMaterials made possible by a grant from the California HealthCare Foundation
12
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 wishes.
Encourage everyone 18 years and older to complete an AHCD.
California POLST Education Program© May 2009 California Coalition for Compassionate CareMaterials made possible by a grant from the California HealthCare Foundation
13
Where Does POLST Fit In?
Advance Care Planning Continuum
Complete an Advance Directive
Complete a POLST Form
Age 18
End-of-Life Wishes Honored
Diagnosed with Serious or Chronic, Progressive Illness (at any age)
Update Advance Directive Periodically
CC OO NN VV EE RR SS AA TT II OO NN
California POLST Education Program© May 2009 California Coalition for Compassionate CareMaterials made possible by a grant from the California HealthCare Foundation
14
POLST vs. Pre-Hospital DNR(Do Not Resuscitate)
POLST and Pre-Hospital DNR:• Physician orders• Address Do Not Resuscitate• Medically frail or those with chronic or serious illness
POLST:• Allows for choosing resuscitation• Other life-sustaining treatments• Honored across all healthcare settings
Pre-Hospital DNR:• Honored outside hospital only (home, assisted living,
SNF, EMS system)
California POLST Education Program© May 2009 California Coalition for Compassionate CareMaterials made possible by a grant from the California HealthCare Foundation
15
POLST vs. PIC(Preferred Intensity of Care)
Both include choices for medical interventions
PIC forms are not medical orders and do not transfer to other settings
POLST can replace the PIC form at SNF
California POLST Education Program© May 2009 California Coalition for Compassionate CareMaterials made possible by a grant from the California HealthCare Foundation
19
Section B: Medical Interventions
CPR
Full Treatment*
DNR
Comfort Measures
Limited Treatment
*Consider time/prognosis factors under “Full Treatment” “Not to be kept on life support if not expected to recover.”
California POLST Education Program© May 2009 California Coalition for Compassionate CareMaterials made possible by a grant from the California HealthCare Foundation
25
Who Can Speak for the Patient
Agent/surrogate decisionmaker Parent, guardian, conservator Closest available relative
California POLST Education Program© May 2009 California Coalition for Compassionate CareMaterials made possible by a grant from the California HealthCare Foundation
26
When to Review POLST
Patient’s treatment preferences change. Change in patient’s health condition. Transfer from one care setting to another. Patient Care Conference.
California POLST Education Program© May 2009 California Coalition for Compassionate CareMaterials made possible by a grant from the California HealthCare Foundation
27
Can POLST be Changed?
Individual with capacity can change the POLST at any time.
A health care decisionmaker may request a change to POLST based on a condition change or new information regarding patient wishes if patient lacks capacity.
If care is medically ineffective or contrary to accepted health care standards.
California POLST Education Program© May 2009 California Coalition for Compassionate CareMaterials made possible by a grant from the California HealthCare Foundation
28
POLST: Depth of the Process
POLST is not just a form. POLST facilitates rich conversations which
integrate patients’ values and preferred preferences for treatment.
POLST is not an Advance Directive, but part of POLST completion is encouraging completion of an AHCD.
POLST incorporates the depth of comfort care which applies to everyone.
California POLST Education Program© May 2009 California Coalition for Compassionate CareMaterials made possible by a grant from the California HealthCare Foundation
29
California POLST Project
C alifornia
The California Coalition for Compassionate Care (CCCC) providesleadership and oversight for POLST outreach activities in California, with support from the California HealthCare Foundation.
C oalition for
C ompassionate
C are
California POLST Education Program© May 2009 California Coalition for Compassionate CareMaterials made possible by a grant from the California HealthCare Foundation
30
POLST Conversation
A rich conversation with each individual patient
Comprehensive Education
To promote excellent conversational skills with patients and families
Consistent Form
Standardized form recognized across care settings
Translating an individual’s wishes for care during serious or chronic illness into medical orders that honor those preferences for medical treatment.
Community Collaboration
Integrating POLST into the community standard of care
California POLST Project
California POLST Education Program© May 2009 California Coalition for Compassionate CareMaterials made possible by a grant from the California HealthCare Foundation
31
California POLST Form
Available at www.capolst.org Print on pulsar pink, 65# card stock paper Copies are acceptable Focus on the conversation
California POLST Education Program© May 2009 California Coalition for Compassionate CareMaterials made possible by a grant from the California HealthCare Foundation
32
POLST Resources
Provider and consumer brochures Frequently Asked Questions (FAQs) Guidebook for healthcare professionals Model policies and procedures Standardized educational curriculum Local POLST coalitions www.capolst.org