What Nurses Need to Know about POLST

• Learn everything a nurse needs to know about Physician Orders for Life-Sustaining Treatment or POLST.
• Understand how to obtain a POLST and what these orders can and cannot do for your patients,
• Review resources and tips to help you, as a nurse, educate patients and their families about POLST.

The physician asks the nurse if the POLST has been filed, and the nurse is baffled because they do not even know what a POLST is. POLST stands for “Physician Orders for Life-Sustaining Treatment.” It is a medical order that specifies what types of medical treatment a person wants or does not want at the end of life.

A POLST form is typically used for patients with serious illnesses or advanced chronic conditions who are at risk of a life-threatening event.

This form is a portable medical order that is signed by the patient or the patient’s legal representative (such as someone who has medical power of attorney), and the healthcare professional (typically a physician or nurse practitioner). It includes specific instructions for medical treatment in various scenarios, such as cardiopulmonary resuscitation (CPR), artificial nutrition and hydration, mechanical ventilation, and comfort measures.

The purpose of a POLST form is to ensure that a patient’s wishes are followed, even if they are unable to communicate or make decisions for themselves. It is recognized as a legal medical order in most states in the United States and is considered an important tool for end-of-life care planning.

Obtaining a POLST

A POLST form is usually completed during a conversation between a patient or their surrogate decision-maker and a healthcare professional who is a prescriber. The conversation is typically part of the advanced care planning process, which involves discussing the patient’s values, goals, and preferences for medical treatment.

If a patient or their surrogate decision-maker decides that a POLST form is appropriate, the healthcare professional will help the individual complete the form and sign it. The form is then kept as part of the patient’s medical record and should be available to emergency medical services (EMS) personnel and other healthcare providers who may be involved in the patient’s care.

The patient should be invited to have a copy of their form and to place it in an accessible location in their own home. In some states, the form is on a bright pink cardstock paper which makes it easily identifiable. Patients who receive a POLST are instructed to tape it to the back of their front door for EMS personnel to have easy access.

It is important to note that the process for obtaining a POLST form may vary by state or country as the use of the POLST form is not universal. Some states or countries may have different types of medical orders for end-of-life care or may not have a standardized form at all. Some may also ask how a POLST is different than an advance directive. The following list contains some things that a POLST is not:

A POLST is NOT:

1. A legal document. While a POSLT form is a medical order, it is not a legal document in the same way that a living will or healthcare power of attorney is a legal document. A POLST form does not designate a healthcare agent or provide instructions for healthcare decision-making outside of the specific medical interventions listed on the form.
2. A substitute for advance care planning. While a POLST form is an important part of end-of-life planning, it is not a substitute for advance care planning. It involves discussions about a person’s values, goals, and preferences for medical treatment in a variety of scenarios, whereas a POLST form focuses on the medical orders for end-of-life care.
3. A one-time decision: A POLST form is not a one-time decision. A person’s preferences for medical treatment may change over time as their health status changes or as they have new experiences with medical care. It is important to revisit the POLST form periodically and update it as needed.
4. A replacement for a Do Not Resuscitate (DNR) order: A DNR order is a medical order that instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) in the event of a cardiac arrest. While a POLST form may include a DNR order, it is not the same thing. A DNR order can be written on its own, separate from a POLST form.

Nurse’s Role in the POLST Process

Nurses play an important role in the POLST process. They may be involved in the initial conversation with patients and their families about end-of-life care planning and can help to explain the purpose and benefits of completing a POLST form.

Nurses can also assist with completing the form itself and may be responsible for ensuring that the form is signed by the appropriate parties and included in the patient’s medical record. Nurses play a large role in being patient advocates by informing patients of their rights and providing patients with education about their health.

It is the physician’s legal responsibility to educate about a diagnosis and prognosis and nurses can reinforce, educate, and assess the patient’s understanding.

In addition to these administrative tasks, nurses can also use the information contained in the POLST form to guide their care of the patient. For example, if a patient has indicated on their form that they do not want to receive CPR in the event of a cardiac arrest, the nurse would be responsible for ensuring that their preference is respected and that comfort measures are provided instead. It is often due to the careful eyes of the nurse to notice that an advance directive or POLST has not been added to the medical record and then correct that error.

Nurses can also serve as advocates for their patients in the POLST process, ensuring that their wishes are respected and that their rights to self-determination are upheld. This may involve advocating for the patient’s preferences with other healthcare providers or even with family members who may be involved in the decision-making process.

Life and death decisions can create complex emotions for an individual and family relationships. Nurses can help the individuals involved navigate the difficult process.

Resources Available for POLST

There are several resources available for both nurses and patients to learn more about POLST. It is important to recognize that the availability and scope of resources may vary by state but general resources include the following:

1. National POLST Paradigm: The National POLST Paradigm is a non-profit organization that provides information and resources about POLST. Their website includes a variety of educational materials including fact sheets, webinars, and videos.
2. American Nurse Association position statement and article: The Pearls of Physician Orders for Life-Sustaining Treatment (POLST): Translating Patient Decisions into Treatment Orders.
3. State POLST Programs: Many states have their own POLST programs, which provide information and resources specific to their state. These programs may be affiliated with a state medical association, department of health, or other organization that serves the state.
4. Healthcare Providers: Healthcare providers, such as physicians, nurses, and social workers can provide information and guidance on POLST. They can also assist with completing the form and answering any questions patients or their families may have.
5. Advance Care Planning Resources: POLST is just one aspect of advance care planning, which involves discussions about end-of-life care preferences and goals. Resources on advance care planning may provide helpful information on POLST.
6. Patient Advocacy Organizations: Patient advocacy organizations, such as the American Cancer Society, American Heart Association, or Alzheimer’s Association, may provide resources and information on POLST.

The Bottom Line

Nurses play a critical role in the POLST process by helping to ensure that patients receive care that is aligned with their goals and preferences at the end of life.

Overall, it is important to understand the purpose and limitations of a POLST form and to engage in comprehensive advance planning that includes discussions with loved ones and healthcare providers about a person’s preferences for medical treatment at the end of life.

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