CPM Summer 2018 - 12

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Features

The vision of the paradigm is to honor FIGURE 1
one's wishes for medical personnel at that
moment of crisis with a POLST form. This
form, however, is not intended for every
individual, rather for those that have a
severe illness, a life expectancy of less than
1 year, and/or a condition where one is not
expected to recover. Many states utilize
these forms and may be worded differently,
however, essentially have the same information. It is vital that this form be explained NY MOLST FORM
in layman terms and discussed in detail of
each section because it can be interpreted
differently. One such example of the various
sections of the Pennsylvania POLST form
are seen below. One section to focus on is
Section D labeled "Artificially administered
Should our POLST forms be revised to
Hydration/Nutrition." The check off boxes include all methods of artificial nutrition
are displayed in the figure with attention (IV and PEG) and to address hydration
given to the wording of "by tube." Is this separately from nutrition to avoid ambiguto be under the assumption it includes total ity? Many surrounding states have similar
parenteral nutrition (TPN)? Do providers forms, however, worded slightly different.
mention such during their discussion?
For example, Maryland's Medical Orders
for Life Sustaining Treatment (MOLST)
We present you a case of a 94-year form delineates between artificially ad-old female wheelchair-bound admitted ministered fluids and nutrition as separate
for encephalopathy secondary to UTI entities seen below but do not mention
and worsening oral intake for the past IV and PEG.
week. The patient was accompanied by
two daughters who were aware she had * May give artificially administered
advanced directives that demonstrated
fluids and nutrition, even indefinitely,
"full code" back in 1998, however, knew
if medically indicated
of a more contemporary document with
further wishes, but were unaware of * May give artificially administered fluids
details due to the third daughter being
and nutrition, if medically indicated,
the surrogate. A POLST was found in
as a therapeutic trial
her chart from 2016 showing "Limited
additional interventions," "no antibiotics," * May give fluids for artificial hydration
and "no hydration and artificial nutrition
as a therapeutic trial, but do not give
by tube" with "no hydration" striked out
artificially administered nutrition
with a penned in statement, "Fluids ok,"
as seen in Figure 1. This was discussed * Do not provide artificial fluids or
with the third daughter who agreed to
nutrition
this, however, wanted IV nutrition for
her mother. The question is, does TPN
coincide with the patient's wishes given
as the statement on the POLST form
mentions no artificial nutrition by tube?

MARYLAND MOLST FORM
12 Summer 2018 Central PA Medicine

Like Maryland, New York's MOLST
form indicates a separate understanding
for fluids/nutrition, and also does not
distinguish artificial nutrition via IV
vs. tube.
* No feeding tube
* A trial period of feeding tube
* Long-term feeding tube if needed
* No IV fluids
* Trial of IV fluids
If we look at Pennsylvania's below,
hydration and nutrition are mentioned,
however, it does not allow just one or the
other. While it does mention "by tube,"
it does not mention IV nutrition.
* No hydration and artificial nutrition
by tube
* Trial period of artificial hydration and
nutrition by tube
* Long-term artificial hydration and
nutrition by tube

PA POLST FORM
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Table of Contents for the Digital Edition of CPM Summer 2018
