POLST 101

1
POLST 101

• Judy Citko, JD
• California Coalition for Compassionate Care
• Tarek Mahdi, MD
• Inland Empire Palliative Care Coalition

2
POLST Hallmarks

• Signed medical orders
• Addresses a range of life-sustaining
  interventions
• Allows for choosing treatment or foregoing
  treatment
• Brightly colored, clearly identifiable,
  standardized form
• Is recognized and honored across all treatment
  settings

3
POLST

• Target population
• Chronic progressive disease
• Surprise question (1 year)

4
Advance Directive vs. POLST
Fagerlin Schneider. Enough The Failure of the
Living Will. Hastings Center Report 20043430-42.
5
POLST versus Pre-Hospital DNR

• Both
• Physician orders
• Address foregoing resuscitation
• Pre-Hospital DNR
• Only allows for foregoing resuscitation
• Honored in pre-hospital setting only
• POLST
• Allows for choosing resuscitation
• Addresses other life-sustaining measures
• Designed for patients in the last year of life
• Honored across all settings

6
POLST versus PIC

• Both
• Physician documents
• Address patient preferences
• Preferred Intensity of Care
• Not standardized
• Legally MD notes
• POLST
• Standardized form
• MD orders

7
National POLST Paradigm Initiative Programs
Established Programs
As of March 2008
Developing Programs
Designation of POLST Paradigm Program status
based on information available by the program to
the Task Force.
No Program (Contacts)
8
(No Transcript)
9
AB 3000 (Wolk)

• Does not mandate use of form
• Requires form be honored
• Unless new orders issued
• Requires
• Physician signature
• Patient or surrogate signature
• Provides immunity

10
(No Transcript)
11
AB 3000 (Wolk)

• Filling Out Form
• Health care provider explains options
• Explains difference from advance directive
• Physician signs
• Physician can issue new order

12
CA POLST Form

• Available at www.finalchoices.org
• Print on pulsar pink, 65 card stock paper
• Copies are acceptable
• Focus on the conversation
  

13
Can POLST be changed?

• Patient
• Can change or revoke the POLST at any time
• Health care decisionmaker
• May request a change to POLST based on condition
  change or known wishes of patient
• If conflict
• Then most recent expression is effective

14
POLST Task Force

• Members
• Represent key constituencies across continuum
• Oversee Statewide Aspects of POLST
• Policy
• Form
• Standardized materials
• Dissemination

15
Local POLST Coalitions

• Local Leadership
• Bring Together Key Constituencies
• Educate
• Facilitate Implementation of POLST

16
Resources

• FAQs
• Guidebook
• Model Policies Procedures
• First Year Lessons Learned
• Standardized Curriculum
• Brochure Materials

17
How POLST Works
18
California Coalition for Compassionate Care

• Visit our website
• www.finalchoices.org
• Questions
• info_at_finalchoices.org