EXECUTIVE SUMMARY

Completeness and consistency of POLST or MOLST forms varies depending on the state they’re completed in, according to two recent studies.

  • Statewide education efforts appear to be effective.
  • Incomplete forms could result in patients receiving unwanted care.
  • Some forms contained inconsistent orders, such as “only comfort measures” and IV fluids.

Less than 10% of completed Physician Orders for Life-Sustaining Treatment (POLST) forms are incomplete or contain contradictory orders, found a recent study.1

The fact that more than 90% of the forms in both study states’ registries were complete and consistent was “reassuring,” says Alvin Moss, MD, the study’s lead author. Moss is a professor at West Virginia University’s Center for Health Ethics & Law in Morgantown.

Researchers reviewed resuscitation (Section A) and level of medical intervention (Section B) orders in 268,386 forms in the Oregon POLST Registry, and 10,122 forms in the West Virginia e-Directive Registry. Some key findings include the following:

  1. Of the forms, 99.2% in Oregon, and 96.6% in West Virginia, contained orders in Sections A and B.
  2. Only 0.11% of forms from Oregon, and 2.53% of forms from West Virginia, contained contradictions. “This should go a long way to ensuring that patients’ wishes are known and respected,” says Moss.

In contrast, a previous study found that more than half of Medical Orders for Life-Sustaining Treatment (MOLST) forms completed in New York state were either incorrect or contradictory.2

“We did not believe the study was representative of POLST completion practices elsewhere, and we studied our databases to see,” says Moss. “We learned the results were the exception rather than the rule.”

In the New York study, researchers analyzed 100 MOLST forms that accompanied patients transported to an ED. They found that 69% had at least one section left blank. Inconsistencies were found in 14% of forms, such as stated desires for “comfort measures only” when the same form indicated a desire to be sent to the hospital, receive IV fluids, and/or receive antibiotics.

“What this shows is a real variability from state to state in how these forms are completed,” says Moss.

West Virginia, Oregon, and California, are the only three states recognized as “mature” programs by the National POLST Paradigm. This means the forms are used in more than 50% of hospitals, nursing homes, and hospices in each region of the state.

“It looks like the education in West Virginia and Oregon has been more successful than in New York,” says Moss.

The researchers attribute the results to statewide education efforts through POLST Paradigm Programs.

“We’re not doing any magic,” says Moss. “It’s just really important to make sure that the people completing the forms, in all healthcare settings, know how to do it properly.”

REFERENCES

  1. Moss AH, Zive DM, Falkenstine EC, et al. The quality of POLST completion to guide treatment: A 2-state study. J Am Med Dir Assoc 2017. pii: S1525-8610(17) 30294-3.
  2. Clemency B, Cordes CC, Lindstrom HA, et al. Decisions by default: Incomplete and contradictory MOLST in emergency care. J Am Med Dir Assoc 2017; 18(1):35-39.

SOURCE

  • Alvin Moss, MD, Professor, Center for Health Ethics & Law, West Virginia University, Morgantown. Phone: (304) 293-7618 ext. 1120. Fax: (304) 293-7442. Email: amoss@hsc.wvu.edu.