The Role of POLST in Advance Care Planning

The Role of POLST in Advance Care Planning

End-of-Life Principles End-Of-Life Care Is About: • Compassion at the bedside • Providing comfort • Honoring patients’ preferences

Advance Care Planning Discussion Documentation Decision

Advance Care Planning "Advance Care Planning Is Not An Event, It's A Process. " * * Susan Tolle, director of the Center for Ethics in Health Care at Oregon Health & Science University 4

Gold Standard Discussing and following a patient’s preferences for end-of-life care is as routine as asking about and responding to a patient’s allergies to medicines

Right to Refuse Medical Treatments • In Georgia, a competent adult has the right to refuse any unwanted medical treatment for any reason • Right to refuse medical treatments includes life support and other life-sustaining treatments • The right to refuse or terminate treatments may be exercised by family members or loved ones

Advance Care Planning Tools • Georgia Advance Directive for Health Care • Georgia Physician Order for Life Sustaining Treatments (POLST)

Georgia Advance Directive for Health Care One document for all health care preferences • Naming a health care agent • Stating treatment preferences • Authorizing organ donation

Georgia POLST • Medical order completed by a health care provider, or started by an attorney • Mechanism to communicate patient preferences for end-of-life treatment • Designed to travel with patient from one care setting to another

Who Should Have a POLST? • Anyone with a significant chronic condition • Anyone choosing “Allow Natural Death”/DNR • Anyone choosing to limit medical interventions • Anyone residing in a long term care facility • Anyone who might die within the next year

Advance Directive vs. POLST ADVANCE DIRECTIVE POLST For anyone over 18 Completed by an individual General instructions for future treatment For seriously ill/frail at any age Completed by a physician Specific orders for current treatment Signed by individual and two witnesses Signed by physician and patient or patient’s surrogate

Adapted with permission from California POLST Education Program © January 2010 Coalition for Compassionate Care of California

Georgia POLST Form • Developed by the Georgia Department of Public Health in 2012 pursuant to Official Code of Georgia Section 29 -4 -18(l) • Available at www. dph. ga. gov/POLST • Use and compliance with POLST form provides immunity to any person acting in good faith

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Georgia POLST Form Five Sections • • • Cardiopulmonary Resuscitation Medical Interventions Antibiotics Artificially Administered Nutrition Reason For Orders And Signatures

POLST Conversation • POLST is not just a check-box form • The POLST conversation provides context for patients/families to: ⁻ Make informed decisions ⁻ Identify goals of treatment • A patient or their Agent/loved one can request alternative treatment or revoke a POLST at any time

Honoring End-of-Life Documents When, in the judgment of the physician, one of “three conditions” are met: • Patient is in a Terminal Condition • Patient is in a permanent state of unconsciousness • Medical judgment that CPR would be futile

Healthcare Agent Responsibilities: • To follow the patient’s known preferences • To honor the patient’s Advance Directive and POLST • To act in the best interest of the patient 18

Healthcare Team Responsibilities: • To follow the patient’s known preferences • To honor the patient’s Advance Directive and POLST without regard to personal views • If unable to honor preferences, facilitate the transfer of patient’s care

“Getting it Right” • Honor all patients wishes • Encourage all patients to have an Advance Care Plan • Utilize POLST when patient condition applies • Apply reasonable medical judgment

Georgia POLST Collaborative • 27+ Statewide Organizations • Part of an national movement to promote POLST • Endorsed by the National POLST Paradigm Taskforce • Vision: All Georgians will have their health care preferences known and honored

Georgia POLST Collaborative • Mission: To improve healthcare at the end-of-life through 1) Promoting the utilization of the POLST form by health care professionals and institutions across the state and 2) Educating Georgians about advance care planning and the role of POLST in having their wishes honored.

“Conversation Project” an effort led by veteran Boston journalist Ellen Goodman and launched in August 2012 with backing from the Institute for Healthcare Improvement. Goodman says 60, 000 people have visited www. theconversationproject. org, and 40% of them have downloaded a conversation-starter kit.

“Conversation Project” Goodman, who launched her project after a difficult experience caring for her own dying mother, says, "What we really need is to change the cultural norm from not talking about it to talking about it. "

Keys • • • Choose a medical decision-maker Decide what matters most in life Flexibility for your decision-maker? Tell others about your wishes Ask doctors and lawyers the right questions

Websites • • www. critical-conditions. org www. dph. ga. gov/POLST www. polst. org www. capolst. org/documents/POLSTFAQ

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