Different from an Advance Directive, the Physician Orders for Life Sustaining Treatment (POLST) is a signed, written medical order created by a physician, physician’s assistant or nurse practitioner designed to be used in emergency situations. This POLST provides specific direction over the health care treatment of people who are seriously ill, have chronic health conditions or who are medically frail. In Utah, this form is also known as the “Utah Life with Dignity Order”.
The POLST form states goals of care given your current medical condition and provides specific medical orders to other providers in case of a medical emergency. The document is valid outside a clinic or doctor’s office; kind of like a prescription for medicine, this medical order form travels with you. It should be placed prominently visible by medical personnel in your medical record and copies should be easily discoverable in your home.
Advance Directives Sometimes Get Ignored
A POLST is different from an Advance Directive. An Advance Directive may be ignored in emergency situations because it doesn’t provide specific, urgent medical orders. First responders need to primarily focus on what is medically possible and reasonable in the emergency situation. There usually isn’t time to consult an Advance Directive to discover who your health care Agent is or to locate and consult that person. Likewise, emergency room personnel will consult an Advance Directive only after they have stabilized you.
Because a POLST is a medical order, first responders and emergency room personnel review POLST forms. They want to know what specific medical orders have been given for you. They abide by its directions. For example, if the POLST form tells first responders not to attempt resuscitation, no CPR or defibrillators will be used.
POLST Provides Different Levels of Medical Interventions
Different levels of medical interventions are discussed in a POLST form. You can elect your level of intervention. For example, if the form simply says: “comfort focused treatments” the patient is treated where they are if possible. If comfort can’t be managed where the patient resides, the patient will still be transferred to the hospital. Staff at the hospital will see that the patient’s simple goal is limited to “comfort focused treatments” and understand the patient’s goal is to get back physically to the condition they were in and nothing more.
If the POLST form orders medical interventions of “full treatment” or “limited additional interventions”, the patient may be transported to the hospital to ensure those levels of intervention are provided. If the POLST form elects “selective treatments,” the patient will be treated at the hospital, but not in the ICU. If the POLST form indicates “full treatments”, the patient may be placed in the ICU and may be placed on a breathing machine if needed.
A POLST form spells out what to do in an emergency. It can be changed or voided at any time. Due to the POLST carrying the weight of a medical order, patients are typically more actively involved in updating their POLST forms than they are in updating Advance Directives. A POLST form ensures difficult conversations can be held in advance of a medical emergency rather during the stressful, time-intensive pressure of the moment. For individuals and their families, this type of health emergency preparedness is the very essence of peace of mind.
To understand further how such a document might benefit you specifically, give us a call today.
