What is a POLST? POLST stands for Provider Order for Life-Sustaining Treatment form. Nevada defines “provider” as either a physician, APRN (advanced practice registered nurse) or PA (Physician Assistant). A POLST is both a legal document and a portal medical order. It allows you to express your wishes for current and future medical care, even when you no longer possess mental “capacity.” Capacity is determined by their provider at the time of the completion of the POLST and is their ability to understand and communicate their health care preferences for options in this medical order. If the patient is able to express their wishes, the POLST is not necessary and yet I believe that we each could become incapacitated (think traumatic accident or heart arrhythmia) at anytime. The POLST is what medical procedures (CPR, antibiotics, etc) the patient would want if they were incapacitated now.
Who should have a POLST? Anyone. Old age is not a requirement for a POLST, although the majority of POLSTs are completed for the elderly. If the patient’s physician would not be surprised should the patient die within one year. Patients who are terminally ill or frail would greatly benefit from a POLST.
When to fill out a POLST? Anytime. The POLST is filled out by the patient and their physician. The physician must sign the form in order for it to be legal. If the patient lacks capacity, then the Durable Power of Attorney/ legal guardian can fill out and sign the POLST. The POLST is best done when the patient has mental capacity to communicate their wishes for medical care. The document can be updated by the patient/guardian as wishes change.
Where to keep your POLST? Carry it with you…Or place it on your fridge (this is a common place EMS workers look if you are found down in your home). If you are in a care facility, they should have a copy.
Why is a POLST important? Medical professionals want to do what you want us to do. If we do not know your wishes, EVERYTHING is done. The treatments may not be what you want. The POLST avoids this by determining if you want aggressive treatment, specific intermediate measures or comfort-focused care. The POLST allows patients to communicate their desired health care treatment currently and in the future in the event they no longer have the ability to do so on their own.
POLST vs. DNR (Do Not Resuscitate) vs. AD (Advanced Directive):
A POLST is a medical order that is valid in any setting. A DNR order is only valid in a healthcare facility. An AD is a legal document, not a medical order, so it cannot be followed by healthcare personnel such as EMS unless a provider writes a medical order to stop resuscitation. EMS must initiate CPR even in the presence of an AD stating the patient does not want CPR because an AD is not a medical order, it is a legal document.
DNR orders are used in circumstances when a patient has lost their pulse, is not breathing or is near death and can no longer communicate.
The POLST is much more than just a DNR order. It guides health care providers which treatments the patient wants. These decisions can include, but are not limited to the use of IV fluids, antibiotics, feeding tubes, intubation and placement on ventilators, or even whether or not a patient wants to be hospitalized or placed into the ICU (intensive care unit).
I encourage my patients to have a DPOA and to let all their loved ones know who is their DPOA. Then each of them needs to know what the patient’s wishes are if they are found down. Do you want CPR? Do you want a ventilator to help you breathe? What is the manner in which you would like to live? (walk? talk? eat independently? think well?) What if those cannot be met? Do you want your DPOA to withdraw care?
Let us do what you want us to do. If you do not express your wishes everything will be done and that may be against your wishes. Be proactive. A POLST is an easy, fast document that begins a conversation between you and your loved ones.