Review the following frequently asked questions to learn more about POLST. If you still have questions, please speak with your health care provider to learn more and to find out if POLST is right for you.
What is the POLST form?
POLST is a physician order that helps give seriously ill patients more control over their end-of-life care. Produced on distinctive bright green paper and signed by both the clinician and patient, POLST specifies the types of medical treatment that a patient wishes to receive toward the end of life. As a result, POLST can prevent unwanted or medically ineffective treatment, reduce patient and family suffering, and help ensure that patients’ wishes are honored.
How is POLST different from my advance directive? Do I need both?
Every adult can benefit from having conversations with their health care professionals and trusted people in their life about what they might want for medical care if a sudden emergency, accident or illness were to happen. These conversations, and the decisions you make, should lead to having documents called advance directives.
Advance Directives can indicate:
- Who you choose to be your legal medical decision maker, also known as medical surrogate, healthcare agent). This is documented in a type of advance directive known as a durable/medical power of attorney for healthcare (DPOA-HC)
- Information about what matters to you, what makes your life worth living, and specific decisions you might want to make about:
-- whether to have life-saving, or life-prolonging treatments such as CPR,
--what level of care you might want in a hospital, whether to have artificial fluids and feeding, dialysis or care in an intensive care unit (ICU). ICU care usually involves more complicated and invasive kinds of medical care (e.g., machines that support breathing and heartbeat, extreme treatments aimed at keeping you alive).
Some Durable Power of Attorney for Healthcare (DPOA-HC) forms allow you to add this information. Or you may want to complete a type of advance directive known as a health care directive which will also ask about your choices for medical care if you are diagnosed with a terminal illness or a condition known as a permanent vegetative state.
What are my options for life-sustaining treatment?
You have the power to determine the kind of treatments you want to receive and the kind of treatments you want to avoid. To help you understand your options, visit the new Honoring Choices Pacific Northwest website for information that will help you begin these conversations with your family and health care professionals.
What information is included on the POLST form?
The decisions documented on the POLST form include whether to:
- Attempt cardiopulmonary resuscitation (CPR).
- Administer antibiotics and IV fluids.
- Use a ventilator to help with breathing.
- Provide artificial nutrition by tube.
Does a POLST form limit the type of treatment I can get? What if I get a simple infection?
POLST gives you more control over receiving treatments you want to receive and avoiding treatments you do not want to receive in the event you are unable to speak for yourself during a medical emergency. If you want everything possible done during a medical emergency, then your health care professional would complete the form showing “CPR” and “Full Treatment.” Conversely, if you want other treatment, your health care professional would complete the form showing “Comfort Measures Only” or “Limited Treatment.”
Additionally, POLST states that ordinary measures to improve the patient’s comfort, and food and fluid by mouth as tolerated, are always provided.
Is POLST required by law?
No. Completing a POLST form should always be voluntary.
Who would benefit from having a POLST form?
POLST is not for everyone. POLST is designed for seriously ill individuals, or those who are in very poor health, regardless of their age.
Most people are too healthy to need a POLST. If something suddenly happened, many healthy seniors would want everything done while more was learned about what was wrong and about their chances of recovery. Healthy people should have an advance directive. Later, if the patient became sicker or frailer, they or their surrogate (for example, their power of attorney for health care) can complete a POLST to turn their treatment wishes into medical orders.
Does the POLST form replace traditional advance directives?
POLST complements an advance directive and is not intended to replace that document. An advance directive is still necessary to appoint a legal health care decision maker, and is recommended for all adults, regardless of their health status.
If someone has a POLST form and an advance directive that conflict, which takes precedence? If there is a conflict between the documents, the more recent document generally would be followed.
Who completes the POLST form?
A health care professional, usually a doctor, nurse, physician assistant or social worker, completes the form after having a conversation with the patient to understand his/her wishes and goals of care. Once completed, POLST must be signed by both the patient and either their physician (MD/DO), a nurse practitioner (ARNP) or a physician assistant-certified (PA-C). The physician, nurse or physician assistant that signs the form assumes full responsibility for its accuracy.
Patients should not be provided a POLST form to complete on their own. A POLST form should never be completed without a conversation with the patient, or his/her surrogate, about diagnosis, prognosis, treatment options and goals of care.
Can the physician signing the POLST form be a naturopath or chiropractor?
At this time, a physician signing the POLST should be an MD (Doctor of Medicine) or DO (Doctor of Osteopathic Medicine). An advance registered nurse practitioner (ARNP) or physician assistant certified (PA-C) may also sign the form.
What happens to my POLST form after it is completed and signed?
What if my loved one can no longer communicate her/his wishes for care? A health care professional can complete the POLST form based on family members’ understanding of their loved one’s wishes. The appointed surrogate decision maker can then sign the POLST form on behalf of their loved one.
The original POLST form, on bright green paper, stays with you at all times. In a hospital, nursing home or assisted living facility, the form will be in your medical record or file. If at home, place your form in a visible location so it can be found easily by emergency medical personnel, usually on a table near your bed, or on the refrigerator.
Can I change my POLST form?
Yes, you can change your POLST at any time should your preferences for treatment change. It is a good idea to review the decisions on your POLST form when any of the following occur:
- You are transferred from one setting to another—for example you go from your home to the hospital, or you are discharged from the hospital to a nursing home.
- There is a change in your overall health, or you are diagnosed with an illness.
- Your treatment preferences change for any reason.
What happens if I don’t have a POLST form?
Without a POLST form, emergency medical personnel, nurses and doctors would not know your treatment wishes. You will most likely receive all possible treatments, whether you want them or not. Talking about your treatment choices with your loved ones and doctor before a problem occurs can guide them and help ensure you get the care you want.
Are faxed copies and/or photocopies valid? Must green paper be used?
Faxed copies and photocopies are valid. Bright green paper is used to distinguish the form from other forms in the patient’s record; however, the form will be honored on any color paper.
Is POLST available as a wallet card or bracelet?
At this time, the Washington state POLST is only available in its standard size—some facilities have on occasion created on their own “pocket” versions of POLST, but these variations of the standard size form are not officially sanctioned by the POLST-sponsoring organizations (the WSMA and the Department of Health).
In Washington state, the Department of Health instructs their paramedics to be guided by the POLST form and only the POLST form. While a “pocket” POLST, or bracelets and necklaces could alert a first responder as to a person's wishes and may encourage them to find the POLST form, medics in Washington are not allowed to act on directions found on that pocket card, or bracelets/necklaces alone.
Can I request a DNR (Do Not Resuscitate) bracelet from my provider?
While some states allow bracelets to serve as instructions to be followed by paramedics in the field, in Washington state, the POLST form is the only set of medical orders approved by the Department of Health that paramedics and emergency medical services teams can follow outside of a medical facility. Bracelets and necklaces could alert a first responder as to a person's wishes and could certainly encourage them to find the POLST form, but Washington state medics are not allowed to act directions found on bracelets or necklaces alone.
Where is POLST used now?
POLST was originally developed in Oregon. There are a number of states that currently have POLST programs in place or that are developing POLST programs. For more information on the national POLST effort, visit www.polst.org.
What if I travel to another state—will my POLST be valid?
If you are traveling to another state, it is a good idea to take both your advance directive and your POLST form with you. Both documents, even if not legally binding, will help health care providers know your wishes.
What if I move to another state—will my POLST be valid?
If you are moving, you should bring your POLST with you to your first appointment with your new health care professional to put your wishes on that state’s POLST form (for a list of states with POLST programs, visit the national POLST program website at www.polst.org). You should also talk to your attorney about updating your advance directive, as some states require you use a specific form in order for your advance directive to be valid.
Do emergency responders in Washington honor the Oregon POLST and vice/versa?
EMTs in Washington state will do their best to honor other state POLST forms as long as the other state form has the basic elements of the Washington form. One significant difference between the Oregon and Washington forms is that a patient signature is required on the Washington state form, but not on the Oregon form. Providers and patients/surrogates need to be aware that if they choose not to sign an Oregon POLST, it may be harder for the EMS or physicians in Washington to honor it.
The Washington POLST will be accepted and honored in Oregon by both EMS and the local hospitals.
It’s recommended that a patient fill out a form for the state where they reside.
Is there a state registry for POLST?
There is not a state registry in Washington state at this time.