POLST: Further protection for the seriously ill—or those facing the end of life

The Physician Orders for Life-Sustaining Treatment (POLST) form is intended for any individual with a serious illness.

If you have a serious health condition, you need to make decisions about life-sustaining treatment. Your physician can use the POLST form to represent your wishes as clear and specific medical orders.

Your physician may use the POLST form to write orders that indicate what types of life-sustaining treatment you want or do not want at the end of life.

The POLST form asks for information about:

  • Your preferences for resuscitation
  • Medical conditions
  • The use of antibiotics
  • Artificially administered fluids and nutrition.

The POLST form is voluntary and is intended to:

  • Help you and your physician discuss and develop plans to reflect your wishes;
  • Assist physicians, nurses, health care facilities and emergency personnel in honoring your wishes for life-sustaining treatment;
  • Direct appropriate treatment by Emergency Medical Services personnel.

POLST – Your questions answered

What is the POLST form?
POLST is a medical order form that helps give seriously ill patients more control over their end-of-life care. Printed on conspicuous green paper, the POLST form can be used to summarize an individual’s previously expressed wishes for life-sustaining treatment and translate them into physician orders for medical treatment.

POLST can prevent unwanted or medically ineffective treatment, reduce patient and family suffering, and help ensure that patients’ wishes are honored.

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.

How does a POLST form work?
An attending physician fills out and signs a POLST form after talking with the individual (or the person's surrogate decision-maker) about preferences for various levels of treatment. (Nurse practitioners and certified physician-assistants are also allowed to sign the form in place of a physician.) The patient or surrogate decision-maker must sign the form as well.

The POLST form then moves with the patient from setting to setting, such as from emergency room to hospital to nursing home to home. The form reduces the need for repetitive end-of-life discussions and provides security for the individual and the physician that expressed wishes will be carried out. No other form streamlines the process in this way.

In a health care facility, the POLST form should be placed at the front of the clinical record. (When the patient and POLST form go elsewhere, the hospital should keep a duplicate of the form.) In the patient's home, the form should be in a prominent location. It will be recognized by emergency personnel as orders to be followed.

If I have a POLST form do I need an advanced directive too?
A POLST form does not replace a health care directive or durable power of attorney nor does an individual need either of those documents to benefit from a POLST form. If you have a signed POLST form, it is recommended that you also have an advanced directive, though it is not required.

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 would be followed.

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 decisionmaker can then sign the POLST form on behalf of their loved one.

Can I change my POLST form?
Yes, you can change your POLST form at any time should your preferences 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.

What if I travel to another state – will my POLST form be valid?
The Washington POLST form is valid in Washington state. 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.

How can I get a POLST form? How can I find out more about POLST?
Patients can request the form from their health care provider. It is important to discuss your goals of treatment with your health care provider so you can decide if POLST is right for you, and how to document your decisions appropriately on the form.

For more information about POLST and related resources, visit the WSMA’s Know Your Choices – Ask Your Doctor campaign website at www.know-your-choices.org.

The WSMA has remained the primary source of information and coordination of Washington state’s POLST program.

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Published 4/15/2014

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