Life-sustaining measures easily captured
The Physician Orders for Life-Sustaining Treatment (POLST) form was developed over a four-year period by a multidisciplinary task force of the Center for Ethics in Health Care at Oregon Health & Science University in Portland. The POLST has since been adapted for use in more than a dozen locales. An adaptation currently in use in Nebraska consists of a two-page form that contains these sections:
• Resuscitation: In the event the patient/resident has no pulse and/or is not breathing, the form provides a place to check that the patient either desires medical providers to resuscitate or do not resuscitate.
• Medical interventions: In the event the patient/resident has a pulse and is breathing, the patient may check any of these choices:
— Comfort measures only.
— Do not hospitalize if comfort measures fail.
— Hospitalize if comfort measures fail.
— Limited additional interventions, including all comfort measures and transfer to hospital, if indicated, and any cardiac monitoring and other interventions checked on the form; but there will be no endotracheal intubation or ventilation, cardioversion, or long-term life support measures given.
— Full treatment. This includes care above plus endotracheal intubation, ventilation, and cardioversion, if indicated.
• Antibiotics: The patient/resident may decide to receive antibiotics or to receive no antibiotics.
• Artificially administered fluids and nutrition: The patient/resident may check any of these choices:
— no feeding tube;
— defined trial period of feeding tube;
— long-term feeding tube;
— no IV fluids;
— defined trial period of IV fluids.
The form also indicates whether the patient/ resident is competent, incompetent, or with someone else who has the authority to consent on his or her behalf, and whether there is appropriate documentation attached, including guardianship papers or power of attorney with health care clause. The POLST also contains a section where changes can be noted after the form is reviewed, which is stated to occur in the event of one of the following:
- the patient/resident is transferred from one care setting or care level to another;
- there is a substantial change in patient/ resident health status, either improvement or deterioration;
- the patient/resident treatment preferences change;
- the following specific event occurs:
- after ___ days of the authority or the last review of this form.