1 / 25

The Patient’s got a POLST…now what?

Treating the person with a POLST in crisis. The Patient’s got a POLST…now what?. Purpose of POLST. To provide a mechanism to communicate patient preferences for end-of-life treatment across treatment settings. POLST Basics. What do you look for first? Patient name MD/DO/PA or NP signature

hali
Download Presentation

The Patient’s got a POLST…now what?

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Treating the person with a POLST in crisis The Patient’s got a POLST…now what?

  2. Purpose of POLST To provide a mechanism to communicate patient preferences for end-of-life treatment across treatment settings

  3. POLST Basics • What do you look for first? • Patient name • MD/DO/PA or NP signature • Is there a T/O or V/O (verbal orders) signed by an RN? --these are ok! • Date signed • If the above criteria are not met, the form is not a valid medical order

  4. Onto the orders • Section A: Cardiopulmonary Resuscitation • When does section A apply? • ONLY when the patient is NOT breathing AND is pulseless. Section A POLST-isms “Until they die, it doesn’t apply” “Once they’re dead, go ahead”

  5. Section B: Medical Interventions • When does section B apply? • When the patient still has a PULSE and/or is still BREATHING Section B POLST-isms “Heart’s got a beat? See Section B for how to treat!” “Is the patient still breathing? Then interventions they’ll be receiving”

  6. Section B: Comfort Measures Only • Do: any intervention that will help keep the patient comfortable • Do: Try to resolve care concerns that are manageable by the providers on scene • If the issue becomes larger, consider calling OLMC • Consider transporting only when the patient cannot be kept comfortable at their primary location • Does not mean do not treat!

  7. Section B: Limited Additional Interventions • Do simple, minimally invasive interventions • Avoid intubation • Do: Transport if there is a simple medical intervention that can be provided by the ED or hospital

  8. Section B: Full Treatment • Treat as per your standard of care for that particular condition!

  9. Scenario 1: • EMS arrives at the home of a 78yom c/o SOB, GCS 15. Pt’s son is on scene and presents you with a POLST that is signed by the physician but bears no patient signature. PMH: COPD, HTN • Can you follow the orders? • Form states DNR, Limited Additional Interventions • Which order is most relevant in the patients’ current medical state? • What treatments would you consider?

  10. Scenario 2: POLST & the CA pt • Arrive on scene of a 52 year old woman, thin and ill- appearing with metastatic breast cancer. She is c/o new onset nausea and pain in her jaw. • What else do you need to know? • Before seeing a POLST form what treatments are you considering?

  11. Scenario 2: 12-lead results Kern, Morton MD “The Different Presentations of Acute STEMI: What Problems Should the Cath Lab Look For?” 12/30/10; www.cathlabdigest.com

  12. Now what? • Do you transport? • Would your decision to transport change if you were able to control the patient’s pain on scene? • If you decide to transport where do you transport to? • What info should you relay to the receiving hospital besides that this is a STEMI patient?

  13. Quiz time! • Can you follow POLST orders that are from a different state than Oregon? • Yes! (Question… contact OLMC) • Are copies of POLST form ok?? • Yes!

  14. Scenario #3 • 72yom, general malaise who stated “I just don’t feel right.” • What is the first thing you need to find out? • The patient is awake and c/o CP & SOB. • Monitor shows V-tach • Treatments? • You decide you’d like to cardiovert • What do you explain to the patient? • Cardiovert asystole • Now what?

  15. Quiz time! • When do you consider using CPAP on the patient with a POLST order of CMO? • The patient has to be alert enough to cooperate in order to try CPAP. • Is it helping? • Yes—then this is a comfort measure • No—then take it off, and try something else

  16. Scenario 4: I’ve fallen and I can’t get up! • 88 year old woman falls at care facility. GCS13. BP 94/70, P 96; unstable pelvis. • RN on scene hands you POLST form: DNR, CMO • Does the POLST form influence your decision to transport? • Does it change the destination?

  17. It’s easy! The Oregon POLST Registry

  18. When should I call? • Elderly, frail patients • Terminally ill patients • Chronic, progressive illness patients • If someone states there may be a POLST but cannot provide a copy • If you are not certain the POLST for you have is current

  19. What is the Oregon POLST Registry? • Secure electronic database of POLST forms. • Owned by the state of Oregon,operated by the Emergency Communication Center at OHSU and available statewide. • Emergency medical professionals treating a patient can access POLST orders if the original POLST form cannot be immediately located.

  20. How do I access the POLST Registry? For emergent needs • Call the POLST Registry EMS Hotline* • State: “This is <your name & title> from<Agency name>, with a POLST form request” • Provide some of the following patient identifiers, as requested by the Registry Hotline staff: • Full name • Date of Birth • Gender • Last 4 SSN • POLST Registry ID # • Home address/residential care facility address • City, County, or zip code *this number is available for EMS, ED and acute care hospital unit use ONLY. It is not for public distribution or dissemination

  21. Do I need to have all those identifiers? • NO! • If possible, start with these identifiers • Registry ID • This may be present in a person’s personal effects on a bright pink sticker (example right) • Date of Birth • First and last name • Hotline staff may request additional identifiers to confirm the identity of a patient

  22. What information will be provided? • The Registry staff can verbally relay: • Section A and B orders • Date the form was signed • Patient’s POLST Registry ID • THE STAFF ARE NOT MEDICAL PROVIDERS, AND CANNOT INTERPRET POLST ORDERS • If you need guidance, contact On-Line Medical Control

  23. Transporting? • Let us know! We will fax a copy of the POLST to your destination hospital

  24. What do I document? • Verbal orders relayed • Example: DNR; Limited additional interventions • Date the form was signed • POLST Registry ID You can always call the business office and request a copy of the POLST for your chart. Calls received after hours will be faxed the next business day

  25. The Oregon POLST Registry Office • EMS Contact Jenny Cook, Oregon POLST Registry Liaison • Call for any non-urgent questions, or educational information or onsite training requests. • Phone: 503-494-1230 • Toll free: 877-367-7657 • Fax: 503-418-2161 • E-mail: polstreg@ohsu.edu • Website: www.orpolstregistry.org

More Related