2011: Antibiotic Section Removed Because of Limited Impact
Since Oregon created the first POLST form, that form served as a model for all other states. Initial versions of the Oregon POLST form included four sections addressing preferences for CPR, Scope of Treatment, Antibiotics and Artificially Administered Nutrition. The Oregon POLST Task Force pursued research data to inform each step of the form’s revision process. Early data confirmed that orders in Section A (CPR/DNR) and Section B (Scope of Treatment) were highly correlated with the level of treatments patients received.
A three state (OR, WV, WI) 90 nursing home study led by Susan Hickman Ph.D., was the first study to examine the degree to which orders related to antibiotic use were honored (see annotation of Journal of the American Geriatrics Society, 2011; 59(11):2091-2099). In a 60 day period about one third of residents of skilled nursing facilities received antibiotics. The rate was the same irrespective of the order to administer or forgo antibiotic use suggesting that orders in the antibiotic section had little impact on the treatment patients ultimately received.
Once a state POLST Program is in wide spread use, making major revisions to the form is difficult. After years of debate, this new data led the Oregon POLST Task Force to remove the separate antibiotic section in 2011 and incorporate the use of antibiotics under ‘Scope of Treatment’ in Section B.
The Task Force was aware of these results several years prior to publication of this study and shared the findings with colleagues in developing states. As a result several states did not include a separate antibiotic section in the first version of their state’s POLST form.