What is POLST?
The POLST form is intended for patients with advanced illness or frailty where accurate predictions cannot be made but death is likely in the foreseeable future.
The POLST form transforms a patient’s treatment plan and goals of care into a medical order. Emergency medical responders and emergency medicine health care professionals follow these orders unless there is new information from a patient or their legal decision-maker. The POLST process encourages shared, informed medical decision-making leading to a set of portable medical orders that respects the patient’s goals for care in regard to the use of cardiopulmonary resuscitation (CPR) and other medical interventions, is applicable across health care settings, and can be reviewed and revised as needed.
Is POLST Required?
Completion of POLST forms should never be mandatory. Facilities may have policies requiring certain patients be offered the opportunity to have the conversation and complete one, but completion of a POLST form should always be voluntary. (Refer to DHS Administrative Alerts)
There is also value in the process of having a POLST conversation even if a POLST form is not completed as a result of the conversation. The POLST process allows patients to have a better awareness of their options for treatment going forward and health care professionals to better understand their patient’s goals of care.
Why was POLST created?
As patients become older and frail, or are diagnosed with an advanced illness, not all are interested in receiving the highest levels of treatment, which is the current standard of care. The POLST form was developed and tested by Oregon clinical ethics leaders who recognized that preferences for life-sustaining treatments of patients, usually documented in advance directives, were frequently not found, too vague, or not transferable, and therefore not honored. They created a new method of translating patient preferences into actionable medical orders that, unlike an advance directive, is based on informed, shared decision-making between a patient and his/her health care professional that provides clear guidance to emergency personnel in a format that is easily located and portable across care settings. The POLST process, the conversation and form, helps ensure patient wishes are elicited, documented and honored, which improves patient care and reduces medical errors.
POLST forms should be offered to patients with advanced illness or who are older and frail and may or may not want all treatment.
Who Completes and Signs the POLST Form?
The POLST form is a medical order and must be signed by the M.D./D.O./N.P./P.A./N.D. to be valid. Patients or their legal surrogate decision maker should be encouraged to sign, but the form is legally valid without their signature.
How do I Void a POLST Form?
A patient with capacity, or the legal decision maker of a patient without capacity, can void the form and request alternative treatment.
For facilities using a paper form, draw a line through sections A through E and write “VOID” in large letters if POLST is replaced or becomes invalid, and send a copy of the voided form to the Oregon POLST Registry.
If included in an electronic medical record, follow voiding procedures of facility/community, and send a copy of the voided form to the Oregon POLST Registry.
How do I Update a POLST Form?
POLST forms should be reviewed periodically and updated if:
the patient is transferred from one care setting or care level to another (including upon admission or at discharge; or
there is a substantial change in the patient’s health status.
How do I Use a Non-English POLST Form?
The POLST form is read by emergency medical personnel, nurses, and physicians who may speak only English. In order for POLST Forms to be portable, they must be in English. However, a Spanish form is available to help explain the orders to Spanish speaking persons, but the only form that is valid to be used in the field is in English version.
Can a Surrogate be Appointed Using the POLST Form?
No. Only an advance directive may be used to appoint a surrogate in Oregon.