Review the following frequently asked questions to learn more about
POLST. If you still have questions, please speak with your physician
or health care professional 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 a medical surrogate or health care 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 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.
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 physician, nurse, physician
assistant, or social worker, completes the form after having a
conversation with the patient to understand their 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
practitioner, or physician assistant who 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 their 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 advanced
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 their 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
physicians 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 physician 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 its website.
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 physicians and health care
professionals 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 physician or 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.
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's
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. Physicians and
patients/surrogates need to be aware that if they choose not to sign
an Oregon POLST, it may be harder for EMS or physicians in Washington
to honor it.
The Washington POLST will be accepted and honored in Oregon by both
EMS and 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.