Sample Policies

The following policies from Oregon hospitals and EMS organizations are provided to help your health care institution develop a POLST policy. Review these policies and identify components that may be applicable to the unique context of your institution. Please note that some aspects of these policies are organization-specific and may not be applicable to your institution. The development of POLST policies should be carefully thought out and responsive to the characteristics of the health care setting.



Tri-County EMS Protocol

POLST in Nursing Facilities

Oregon POLST Task Force Statement on Following Other States’ POLST Orders

Health care professionals are occasionally reluctant to honor POLST forms that were signed by a physician, nurse practitioner or physician assistant who is not licensed in Oregon. Professionals are often concerned that forms signed by an out-of-state professional are not valid. However, Oregon Medical Board administrative rules require that POLST forms be honored, including those from other states. For the Oregon POLST Task Force’s full statement on following other states’ POLST orders (including detailed explanation of the relevant administrative rules), click the following link:

Oregon POLST Task Force Statement on Following Other States’ POLST Orders (PDF)

Inclusion of POLST in Electronic Medical Record

With the increasing use of Electronic Medical Records (EMR), it has now become possible to include POLST forms in patients’ electronic records. The inclusion of POLST forms in EMRs requires a documented institutional policy to ensure that POLST forms are included in the appropriate section of the EMR and that the most recent POLST form can easily be identified. To provide guidance for developing a policy for the inclusion of POLST in EMRs, OHSU’s POLST in EMR policy is provided below:

OHSU’s Inclusion of POLST in Electronic Medical Record (PDF)