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A FAQ on POLST and Advance Directives

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February 2, 2015

What are the primary differences between an Advance Directive and a POLST form? Can I alter my POLST once it is completed?  Do I also need an Advanced Directive? Examine the various questions and concerns people have about the legal ramifications of completing the medical forms that apply to end-of-life situations.

What are the primary differences between an Advance Directive and a POLST form?

ADVANCE DIRECTIVE

  • For anyone 18 and older
  • Provides instructions for future treatment
  • Appoints a Health Care Representative
  • Does not guide Emergency Medical Personnel
  • Guides inpatient treatment decisions when made available

POLST

  • For persons with serious illness — at any age
  • Provides medical orders for current treatment
  • Guides actions by Emergency Medical Personnel when made available
  • Guides inpatient treatment decisions when made available

Select FAQs from Coalition for Compassionate Care of California

http://capolst.org/polst-for-healthcare-providers/

“Why was POLST developed?”

“POLST was developed in response to seriously ill patients receiving medical treatments that were not consistent with their wishes. The goal of POLST is to provide a framework for healthcare professionals so they can provide the treatments patients DO want, and avoid those treatments that they DO NOT want

“Is POLST mandated by law?”

“Filling out a POLST is entirely voluntary. However, California law requires that the physician orders in a POLST be followed by healthcare professionals, and provides immunity from civil or criminal liability to those who comply in good faith with a patient’s POLST requests. [Reference: AB 3000, Part 4, Section 7, Probate Code Section 4782.]”

“Does the POLST form replace traditional Advance Directives?”

“The POLST form complements an Advance Directive and is not intended to replace that document. An Advance Directive is still necessary to appoint a legal healthcare 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 would be followed.”

“Can a POLST form be completed for patients who can no longer communicate their treatment wishes?”

“Yes. A healthcare professional can complete the POLST form based on family members’ understanding of their loved one’s wishes. The appointed decision-maker can then sign the POLST form on behalf of their loved one.”

“Can a patient’s POLST form be changed?”

“Yes, the POLST can be modified or revoked by a patient, verbally or in writing, at any time. Changes may also be made by a physician, or requested by a patient’s decision-maker, based on new information or changes in the patient’s condition.”

“When should a patient’s POLST form be reviewed?”

“It is good clinical practice to review a patient’s POLST form when any of the following occur:

  • The patient is transferred from one medical or residential setting to another;
  • There is a significant change in the person’s health status, or there is a new diagnosis;
  • The patient’s treatment preferences change.”

ADDITIONAL CONSIDERATIONS

If a POLST contains a DNR order, how is this handled during the peri-operative period?

There is no one answer to this question. However, in the case of a DNR order--either free-standing or in a POLST--it should never be "automatically suspended." Many hospitals have a policy that requires a conversation about being full code during the pre-op period. After that conversation, a patient/decisionmaker may refuse to become full code. Should a patient refuse to change code status, the team may then refuse to do surgery with the DNR in place. If the patient changes his/her decision about code status after that conversation, then the POLST must be voided and rewritten & signed each time after a discussion between the patient/decision-maker and MD.