NewsLine - May 2011 - (Page 4)

continued from page 2 An advantage of POLST over an advance directive is that the decisions embodied in POLST require physician involvement and signature. For example, POLST legislation that was enacted in California states that when the form is signed by a physician and the patient or the patient’s decision maker, it is a valid order anywhere in any setting, and must be followed by healthcare providers. The law also provides immunity for any medical action taken to implement the orders on the POLST. A recent multi-state study published in The Journal of the American Geriatric Society demonstrated that POLST may be more effective than traditional advance directives alone in ensuring that patients’ preferences for life-sustaining treatments are recorded and honored. POLST and advance directives each have their place in a continuum of advance care planning, as illustrated in the diagram on page 5. POLST vs DNR Unlike the vague and frequently misunderstood Prehospital DNR order, the POLST order POLST vs Prehospital DNR POLST: Allows for choosing resuscitation Allows for other medical treatments Honored across all healthcare settings Prehospital DNR: Can only use if choosing DNR Only applies to resuscitation Only honored outside the hospital distinguishes between cardiopulmonary resuscitation for someone pulseless and not breathing from interventions such as intubation and mechanical intervention. The former has extremely poor effectiveness in patients facing advanced illness, while the latter is often effective (though burdensome) in many debilitated patients. The POLST Conversation One of the ways that POLST helps patients control their endof-life treatment is to facilitate communications about the topic between a patient, their family, and their healthcare providers. POLST provides a framework for guiding the conversation which makes it easier to have the discussion and more likely that patients will express their wishes and have those wishes honored. One of the issues that makes these conversations difficult is that healthcare providers have long used the term “DNR” without a clear definition of exactly what the term means. Even providers in the same institution, working together for many years, will often have different interpretations of the meaning of a DNR order. With a long list of possible lifesustaining treatments available, it is essential that the term DNR have a well-defined meaning so it will be interpreted consistently. The POLST paradigm defines DNR as efforts to resuscitate a patient in cardiopulmonary arrest. By using this definition, we separate the conversation about goals of care and treatment options into two parts: (1) what should be done if the patient is in cardiopulmonary arrest, and (2) what should be done prior to cardiopulmonary arrest. When the patient is in cardiopulmonary arrest, is the goal to attempt resusciatation (perform CPR and ACLS per protocol), or to allow a natural death (DNR)? We must also make a point to specifically discuss if the patient has any preferences for 4 NewsLine

Table of Contents for the Digital Edition of NewsLine - May 2011

POLST: An Evidence-based Tool for Advance Care Planning
A Message From Don
ICD-10: It’s Time to Begin Preparing
26th MLC Supporters (display ad)
Experience the ACHC Difference (display ad)
LifeBeat at Southern Tier Hospice and Palliative Care
Introducing NHPCO’s Custom Print Marketplace (display ad)
Voice of NCHPP: Spiritual Care: A Physician’s Perspective
NCHPP: Getting Involved
Recruiting Problems? HMR (display ad)
New - Hospice MDP Summer School (display ad)
CMS Clarifies Aspects of the Face-to-Face Encounter
Harvest: A New Film That Will Resonate With Members
Member News and Notes
Upcoming Educational Offerings
Cover 2

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