Provider Orders for Life- Sustaining Treatment (POLST)

1 Provider Orders for life - Sustaining Treatment (POLST). by Marsha A. Goetting, , CFP , CFCS, Professor and Extension Family Economics Specialist; and MSU Extension Agents Virginia Knerr, Broadwater County, and Linda Williams, Chouteau County A POLST form ( Provider Orders for Life- Sustaining Treatment ) gives you control over your medical treatments near the end-of- life . Once signed by you and your physician, nurse practitioner, or physician assistant, the POLST form is MontGuide recognized as a medical order that will be honored by all Montana health care providers.

2 MT201112HR Revised 7/14. What is POLST? similar to those in other states. The Montana A form called POLST ( Provider Orders for life - POLST website is Sustaining Treatment ) has been created that Why is POLST needed in Montana? gives you control over your medical treatments near your end-of- life . Once signed by you and Only 20 to 30 percent of Americans have some your physician, nurse practitioner, or physician type of an advance health care directive in assistant, your POLST form is recognized as an which they have provided instructions about actual medical order that will be honored by future health care preferences should they be all Montana health care providers.

3 The POLST seriously ill and unable to make such decisions. form becomes a part of your medical records However, these advance directives were often and accompanies you when you are transferred unavailable to health care providers because between health care facilities. they were not transferred with the patient from one health care facility to another. How did POLST develop in Montana? Other advance directives were not followed POLST was first established in Oregon in because they did not provide specific details 1991 in response to seriously ill patients about the patient's preferences for end-of- life receiving medical treatments that were not Treatment .

4 In some cases, a person's advance consistent with their wishes. The program is directive was overridden by medical providers now accepted or under development in 43 or family members because of vagueness within states. Participating states can be found at the the document. National POLST website, The Montana POLST form addresses Because of the program's success, the these issues and assures that your wishes are Montana health care community believed defined and followed if you have a serious POLST should be made available in our Life- limiting illness or if you are in a terminal state.

5 The Montana Board of medical condition. Terminal condition is defined in the Examiners and the Department of Public Montana Rights of the Terminally Ill Act as an Health and Human Services (DPHHS) incurable or irreversible condition that, without made the POLST form available in January the administration of Life- Sustaining Treatment , 2010. The POLST form and guidelines were will, in the opinion of the attending physician revised in 2011 and 2014 by the Montana or attending advanced practice registered nurse, POLST Coalition to make them substantially result in death within a relatively short time.

6 For More Online MontGuides, Visit POLST is a voluntary form used by your directives, providers for discussing and indicating what If you do not have access to the types of Life- Sustaining Treatment you want or Web, see page 6 for ordering information. do not want at the end of life . In the Montana While Montana law allows you to convey Rights of the Terminally Ill Act, Life- Sustaining your wishes about Life- prolonging medical Treatment is defined as any medical procedure treatments in an advance directive and/or health or intervention that, when administered to a care power of attorney, these documents are not qualified patient, will serve only to prolong the a medical order like the POLST form.

7 Dying process. If you have several documents that address your desires about medical Treatment near I already have a living will/advanced the end-of- life , you should review all of those directive and/or health care power documents to ensure consistency among them. of attorney; why should I complete a Inconsistencies among multiple forms and POLST form? documents may result in confusion to health The Montana Rights of the Terminally Ill Act care providers and limit their ability to make enables an individual who is of sound mind decisions on your behalf.

8 Family members may and who is an adult (18 or more years of age) to also have disagreements about which document make a declaration (living will) that governs the should have priority. withholding or withdrawing of Life- Sustaining Treatment when he or she is in a terminal I already have a Comfort One or DNR. condition. A declaration must be signed by the order ; why do I need to complete a person executing it and by two witnesses. POLST form? A Montanan can also designate another Beginning in 1989, Montanans could limit the individual (designee) to make decisions about care they receive in a medical emergency with the withholding or withdrawing of life - a Comfort One order that was completed by a Sustaining Treatment if he or she is unable to do physician.

9 Enrollment was limited to those who so. For more information about a declaration, had a terminal illness or to those for whom a read the MSU Extension MontGuide, Montana physician had ordered a do not resuscitate . Rights of the Terminally Ill Act (MT199202HR). (DNR). Comfort One was intended for a person While Montana law allows you to convey your who was not being cared for in a facility. wishes about Life- Sustaining medical treatments By displaying the Comfort One form, in a declaration, this document is not a medical wallet card or bracelet to emergency medical order like the POLST form.

10 Service personnel, a person could avoid most Montanans who want to provide additional resuscitation. While the Comfort One program details about their health care preferences has been eliminated from the Emergency are encouraged by health care providers and medical Services system and replaced by attorneys to have a health care power of POLST, existing Comfort One documents attorney or an advance directive, in addition to and bracelets will be honored by Emergency POLST, but one is not required. medical Technicians (EMTs). Comfort One Advanced directive forms are available from bracelets cannot be transferred from one local hospitals and doctors.