Required Elements of a POLST Paradigm Program

1
Required Elements of a POLST Paradigm Program

• Bud Hammes, PhD
• Gundersen Lutheran Health System
• bjhammes_at_gundluth.org

2
Why core elements?

• A POLST Paradigm is a type of clinical
  intervention.
• Certain elements are essential in order for the
  system to be effectively replicated.

3
There are 9 required elements

1. Form constitutes medical orders. Must be
   followed by health professionals who provide care
   across the continuum of care (Requires a
   signature of physician or other licensed HP and
   date/time.)
2. Form is standardized in format, color, and
   wording.

4
9 required elements (cont)

1. Form is primarily used with patients with
   advanced, progressive chronic illness, those for
   whom the surprise question answer is no, or
   those who wish to further define their
   preferences.
2. Form may be used to limit treatment or to express
   the desire for full treatment

5
9 required elements (cont)

1. Form provides clear direction about the desired
   response if the patient is pulseless and apneic.
2. Form allows for clear directions about other
   life-sustaining treatment if the patient has
   serious cardiac or pulmonary problems and
   expresses instructions regarding the use of
   artificial nutrition and antibiotics

6
9 required elements (cont)

1. Form transfers with the patient
2. Health professionals are trained to use the form
   and to have discussion to complete the form.
3. Measures are made to monitor the success of the
   program and its implementation

7
Optional Elements

• Signature of patient (or surrogate)
• Reciprocity
• Surrogates can complete forms
• Some states also have DNR bracelets
• Section for basis of order
• Order signed by NP or PA
• Space to review document

Signature highly recommended by National POLST
Paradigm Task Force