NHPCO NewsLine Fall 2021 - 34

continued
I look forward to the day where intimate knowledge
of individual state POLST forms and reciprocity laws
is not required to answer the question. Wouldn't it
be nice if POLST were like a driver's license? You only
need one and you can travel throughout the US
without thinking about whether it will be valid when
you cross a state line. That is the goal with the
national POLST form.
Today, however, the caller is typically unhappy with
my answer because it means they must spend time
and effort on multiple provider visits in multiple
states and then keep track of the multiple forms
they need to keep in their possession. (Remember,
the appropriate population for POLST are those who
are seriously ill or frail so adding another burden on
them is generally not well received.)
For POLST to really be part of the standard of care
throughout the US it is necessary it be simple,
meaning that it is easily portable across state lines,
recognized and understood.
RECIPROCITY IS A RED HERRING
When given a problem to solve people
" systematically default to searching for additive
transformations, and consequently overlook
subtractive transformations. " Focusing on adding
reciprocity laws or regulations to address POLST
portability, rather than subtracting the 45 POLST
forms to just one, is an example.
Every state variation of POLST unnecessarily limits
the value of POLST and creates unnecessary
administrative burdens and worries on the very
patients POLST intends to help. Consider that we
have:
▌ 45 different POLST forms exist (the order of the
treatment orders on the form, what orders are
included, etc)
▌ 6 colors (excluding the various shades of pink)
▌ 17 different acronyms (20 names when you spell
them out).
Addressing reciprocity is a poor workaround to
achieving true POLST portability. On paper it looks
great, but the reality is that 45 variations of what
could the same document creates real challenges for
health care professionals and, by extension, patients.
Consider the emergency medical service (EMS)
personnel showing up during an emergency. The
information that drives the patient care decisionmaking
process outside of medical facilities is unique
from other care settings. Within seconds, EMS must
elect to begin or deescalate patient resuscitation.
These decisions are often made with less
information and with fewer personnel present than
in a hospital emergency department or floor unit - in
the hospital setting, staff have the advantage of
searching for available records and orders, while
EMS personnel may or may not have access to a
hardcopy of patient care documentation. Fewer
personnel on scene also means that anyone present
dedicated to looking for records or documentation
are not providing direct care, and in particularly
resource-lean environments, this can mean critical
interventions are delayed or not performed at all.
Further, EMS is protocol-driven work and, if staff are
trained on POLST at all, they are being trained to
their specific state POLST form. How do you think
an EMS provider, trained on the pink TPOPP form
(the Kansas-Missouri version of the POLST) in an
emergency situation will react to seeing a goldenrod
LaPOST form (the Louisiana version)? Or the green
POLST form from New Jersey? Even if they
immediately recognize it as the same form as the
TPOPP (which is a question in and of itself), they
must immediately next wonder if they are legally
permitted to follow it and take time (if they have the
manpower or ability to do so considering the
patient's condition) to talk with medical command
or dispatch to get instructions-all the while the
patient is being treated as aggressively as possible
in an attempt to save their life (something they may
not have wanted).
It is not just EMS having trouble: part of my initial
POLST work included leading the Oregon POLST
34 Newsline / Fall 2021
NHPCO NewsLine Fall 2021

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