What is POLST Physician Orders for Life Sustaining

What is POLST? Physician Orders for Life Sustaining Treatment California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 1

Why POLST? 1. Patient wishes often are not known. – The Advance Healthcare Directive (AHCD) may not be accessible. – Wishes may not be clearly defined in AHCD. – The AHCD is not a physician order. 2. Allows healthcare providers to know and honor wishes during serious illness. California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 2

Case Study: What We Know California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 3

Case Study: What We Didn’t Know tion ssocia A l a ic ia Med aliforn 009 2000 -2 ©C California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 4

Case Study: What Happened · AHCD not transferred with patient. · DNR wishes not documented. · Over-treatment against patient wishes. · Unnecessary pain and suffering. California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 5

What is POLST? · A physician order recognized throughout the medical system. · Portable document that transfers with the patient. · Brightly colored, standardized form for entire state of CA. California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 6

What is POLST? · Allows individuals to choose medical treatments they want to receive, and identify those they do not want. · Provides direction for healthcare providers during serious illness. California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 7

Who Would Benefit from Having a POLST Form? · 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 ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 8

POLST History · POLST development began in Oregon in 1991. · Expanded to more than half of the United States. California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 9

National POLST Paradigm Programs www. polst. org *As of January 2014 Mature Programs Endorsed Programs Regionally Endorsed Program Developing Programs No Program (Contacts) Programs That Do Not Conform to POLST Requirements

POLST Success Oregon Study: Location of Death and POLST Orders • 58, 000 deaths reviewed, 31% had POLST in Oregon Registry • Patient treatment choices honored, including avoiding dying in hospital Full Treatment 1, 153 Hospital Death 44. 2% Out Hospital Death 55. 8% Comfort Measures Only 11, 836 Limited Interventions 4, 787 Hospital Death 22. 4% Out Hospital Death 77. 6% Fromme EK, JAGS 2014 California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 11 Hospital Death 6. 4% Out Hospital Death 93. 6%

POLST in California · The Coalition for Compassionate Care of California (CCCC) is lead agency. · Support from California Health. Care Foundation. · Grassroots efforts of local POLST coalitions and communities. California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 12

POLST in California Effective January 1, 2009 California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 13

POLST in California · One form for entire state. · Use not mandated. · Honoring form is mandated. · Provides immunity from civil or criminal liability. AB 3000, Wolk. Part 4, Sec 7, Probate Code Section 4782 California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 14

POLST vs. Advance Healthcare Directive · · · POLST complements the Advance Healthcare Directive (AHCD). POLST is not intended to replace the AHCD. Both are legal documents. AB 3000, Part 4, Sec 3, Probate Code 4780 (3) (c) California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 15

POLST vs. Advance Healthcare Directive POLST AHCD For seriously ill/frail, at any age · Physician orders for medical treatment For anyone 18 and older · General instructions for treatment · Appoints decisionmaker · · California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 16

Where Does POLST Fit In? Advance Care Planning Continuum Age 18 C Complete an Advance Directive O N Update Advance Directive Periodically V E R S Diagnosed with Serious or Chronic, Progressive Illness (at any age) A T Complete a POLST Form I California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation O N 17 Treatment Wishes Honored

POLST vs. Pre-Hospital DNR (Do Not Resuscitate) · Similarities: – – – Physician orders. Address Do Not Resuscitate. Intended for medically frail or those with chronic or serious illness. California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 18

POLST vs. Pre-Hospital DNR (Do Not Resuscitate) POLST Pre-Hospital DNR Allows for choosing resuscitation · Allows for other medical treatments · Honored across all healthcare settings Can only use if choosing DNR · Only applies to resuscitation · Only honored outside the hospital · · California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 19

POLST vs. PIC (Preferred Intensity of Care) POLST Consistent form for CA · Is a medical order · Honored across all healthcare settings · PIC form is different in every SNF · Is not a medical order; similar to a doctor’s note · Only used within the SNF · California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 20

POLST vs. PIC (Preferred Intensity of Care) · POLST can replace the PIC form at SNF. · POLST is a voluntary form. California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 21

CA POLST Form – Front Side California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 24

Section A: CPR California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 25

Section B: Medical Interventions California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 26

Diagram of POLST Medical Interventions CPR DNR Full Treatment* Selective Treatment Comfort-Focused Treatment *Consider time/prognosis factors under “Full Treatment” “Trial Period of Full Treatment” may be checked if prolonged life support is not desired. California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 27

Section C: Artificially Administered Nutrition California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 28

The POLST Conversation · POLST is not just a check-box form. · The POLST conversation provides context for patients/families to: – – Make informed choices. Identify goals of treatment. California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 29

Section D: Information and Signatures California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 30

Who Can Speak for the Patient? · Surrogate decisionmaker/agent · Parent, registered domestic partner, guardian, conservator · Closest available relative California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 31

CA POLST Form – Back Side California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 32

Who Can Help Complete POLST? · · Healthcare providers – “licensed, certified, or otherwise authorized to provide healthcare in the normal course of business. ” Best practice suggests use of those trained in the POLST Conversation: – – – Physicians Nurses, Nurse Practitioners, Physician Assistants Social Workers Chaplains Social Service Designees California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 33

Directions – Completing POLST California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 34

Directions – Using POLST California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 35

Directions – Reviewing/Modifying/Voiding POLST California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 36

When Should POLST be Reviewed? · Transfer from one care setting to another. · Change in patient’s health condition. · Patient’s treatment preferences change. · Patient Care Conference. · Recommendation: Update POLST forms to the 2014 version when reviewing 2009 or 2011 POLST forms. California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 37

Can POLST be Changed? · Patient with capacity can request alternative treatment or revoke a POLST at anytime. · Legally recognized decisionmaker may request a change based on condition change or new information regarding patient wishes. California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 38

Where Should We Keep POLST? Original pink POLST stays with patient · At SNF/Hospital: – – – File in medical chart (with AHCD). Send original with patient upon return to home/SNF/hospital. Keep copy if patient transferred; review POLST upon patient’s return. California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 39

Where Should We Keep POLST? · At home: – – Post in easy-to-find location (with AHCD). Give to EMS to transport with patient. California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 40

POLST: Depth of the Process · POLST is more than a form. · POLST: – – – Facilitates rich conversations with patients/families. Complements the AHCD. Incorporates the importance of comfort. California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 41

California POLST Project The Coalition for Compassionate Care of California (CCCC) provides leadership and oversight for POLST outreach activities in California, with support from the California Health. Care Foundation. C oalition for C ompassionate C are of C alifornia California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 42

California POLST Project Translating an individual’s wishes for care during serious or chronic illness into medical orders that honor those preferences for medical treatment. POLST Conversation A rich conversation with each individual patient Community Collaboration Consistent Form Integrating POLST into the community standard of care Standardized form recognized across care settings Comprehensive Education To promote excellent conversational skills with patients and families California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 43

California POLST Form · Available at www. ca. POLST. org – · Translations available May be purchased from: – – www. med-pass. com (bulk forms/paper) www. cmanet. org (POLST Kit) California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 44

California POLST Form · · Print on Ultra Pink, 65# card stock paper Copies/faxes on any color paper are acceptable Focus on the conversation California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 45

POLST Resources · Consumer Brochure · FAQs California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 46

POLST Resources · Model policies and procedures · Standardized educational curriculum · Local POLST coalitions · www. ca. POLST. org California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 47

Questions? California POLST Education Program ©August 2014 Coalition for Compassionate Care of California Materials made possible by a grant from the California Health. Care Foundation 48