Have you heard of POLST? It stands for Physician’s Orders for Life Sustaining Treatment. In Pennsylvania, it is known as the Pennsylvania – Orders for Life Sustaining Treatment. (See what they did there?). The use of POLST recently came up at a recent LVAA Policy Committee meeting hosted by C.A.R.I.E. Here is what you need to know:
POLST is a program that allows a patient and his or her physician to create medical orders detailing treatment wishes for end-of-life care. It is made to be used by people with serious or chronic illness. The idea is that you will be given an opportunity to express your wishes for end-of-life care, and your medical attendants will follow these wishes. There is a standardized form that will be completed by you and your doctor, which then becomes part of your medical record. Other medical attendants can follow the POLST instructions when the form is signed by your doctor. The instructions cover whether or not you want CPR, or other medical interventions such as intubation , IV fluids, antibiotics, and/or artificial nutrition or hydration. The PA Department of Health has endorsed a PA-POLST form. Use of the POLST form is completely voluntary. There is no law in Pennsylvania requiring the use of a POLST form.
A potential problem with the use of a POLST is that, under current Pennsylvania law, Emergency Medical Services (EMS) protocols direct that even when a POLST is presented, CPR and/or resuscitation “should be initiated and medical command should be contacted as soon as possible.”1 In other words, if an ambulance comes to your house because you are unconscious, even if your POLST is provided to the EMS team, they will still start to resuscitate you until they can contact your physician for further instruction. That is because Pennsylvania already has a legal framework for this situation, called the Out-of-Hospital Nonresuscitation Act.
The Out-of-Hospital Nonresuscitation Act, 20 Pa.C.S.A. § 5481, allows a physician for a patient with an end-stage illness, or who is permanently unconscious, to sign a Do Not Resuscitate (DNR) Order at the request of the patient or the patient’s surrogate decision-maker. The patient can provide the Order, or an official DNR bracelet or necklace, to EMS technicians. Once the EMS personnel see the order, bracelet, or necklace, they must comply with the order. In contrast, EMS personnel do not have to legally comply with a POLST and, under current regulations, they are instructed NOT to comply with a POLST until your physician is contacted for further instruction.
In light of this, use of POLST in Pennsylvania will probably be most effective in a long-term care setting, where medical records are readily available. POLST could be a useful tool when it is used as one part of your advance care plan. To make sure that your end-of-life treatment goals are made known and followed by your family and physicians, you should also consider the complementary use of a Health Care Power of Attorney with Advance Directives, and/or a Do Not Resuscitate Order, if appropriate.
For more information on PA-POLST, visit The Aging Institute.
1. Pennsylvania Statewide Basic Life Support Protocols, Pennsylvania Department of Health, Bureau of Emergency Medical Services, Effective July 1, 2011.