- Describe your topic.
- The MOLST (Medical Orders for life sustaining treatment) and POLST (Practitioners Orders for Life Sustaining Treatment) forms have been in use for almost 10 years, advertised as legally binding medical orders when completed by a physician or nurse practitioner and the patient or designated medical decision maker. How are facilities incorporating the information documented on these forms into the treatment of an individual when the person is presented in the ER or facility with an acute episode of illness? I am finding that at many facilities the clinicians are not looking for, or incorporating the directives into the plan of care. Our Baby boomers are increasing in the population of the patients with chronic disease who may benefit from completion of these documents.
- Describe why this topic is important.
- Individuals create these documents to ensure that their wishes for end of life care are followed. The forms can help to create a plan of care that is appropriate to the individual and may limit the aggressiveness of care. The statistics on successful resuscitation of a chronically ill person leaving a hospital alive after a cardiac arrest are dismal. People have the right to direct their care and MOLST/POLST is one way to do this. The use of futile treatment can be limited by creation of these documents allowing for respect of individuals and better use of health care dollars.
- Tell us why you are suggesting this topic.
- Overtreatment of individuals and futility of care are huge morally distressing areas for healthcare workers. The POLST/MOLST are one way of respecting patients and families and allowing appropriate treatment to be given. They may free the clinicians from providing overly aggressive and futile treatments by removing the fear of malpractice for not intervening with an intervention that may have only prolonged the patient's dying process. The US needs to encourage the discussions that are necessary to complete the forms and then to enforce practices to follow the directives as completed.
- Target Date.
- Describe what you are doing currently and what you are hoping will change because of a new evidence report.
- I am currently a practitioner in Palliative Care and we create these forms on a daily basis. Reports from patients/families indicate they feel empowered when given the opportunity to declare what their wishes are. That being said we also see patients every day come into the hospital who have a POLST in their electronic chart and it is not addressed in their code status or in conversation with the patient about ongoing care. There is some reported fear of malpractice claims by ER physicians if they don't "do everything" which makes them not address the POLST. I believe if we could find that there was a successful decline in futile treatment and no malpractice claims for following a POLST form we could prove the same to the clinicians.
- How will you or your group use the information from a new evidence report?
- My workgroup from NJHA on End of life care would use the information to educate clinicians on the benefits of the POLST, demonstrate lack of malpractice claims for following it and possibly show decrease in unwanted care from obtaining decisions from patients prior to an emergent event.
- How would you or your group plan to disseminate information from the report? Who would you plan to disseminate it to?
- Our facility would create an education plan for presenting the POLST, benefits and success of same, along with clarification on protection from malpractice based on following a POLST directive. We have created a way for clinicians to view the electronic POLST and our collaboration with a state wide group on electronic storage for POLST would be strengthened by obtaining "buy-in" from physicians on creation, use and review of POLST forms. We do however need some real stats and information to sway the clinicians and to this date we do not have that info.
- Do you know of organizations that could use an evidence report to change clinical practice? Are you a part of, or have you been in contact with, any organizations that might implement the research findings of an evidence report?
- Every hospital is trying to decrease readmissions and use of inappropriate measures in providing care. the POLST is one way to help obtain patient's directions and document them to the wider medical community for review whenever necessary. I participate on NJHA subcommittees along with multiple community collaborative groups to move the POLST forward and all of them would appreciate increased use of POLST forms.
- Information About You: (optional)
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- Provide a description of your role or perspective.
- I am a Nurse Practitioner who is Director of Palliative Medicine at a small community hospital
- If you are you making a suggestion on behalf of an organization, please state the name of the organization.
- Shore Medical Center
- Please tell us how you heard about the Effective Health Care Program.
