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POLST New Documentation for Patients & Quality Care. Illinois’ s IDPH Uniform DNR Advance Directive. IDPH DNR … can also be called POLST now. Illinois is changing the current IDPH DNR to meet the national POLST standards used in other states

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slide1

POLST

New Documentation for Patients & Quality Care

Illinois’ s IDPH Uniform DNR Advance Directive

idph dnr can also be called polst now
IDPH DNR …can also be called POLST now
  • Illinois is changing the current IDPH DNR to meet the national POLST standards used in other states
  • POLST stands for “Physician Orders for Life-Sustaining Treatment”
  • POLST reduces medical errors by improving guidance during life-threatening emergencies

3

slide3

Who is POLST Designed For?

Focusing on patients as partners in their care.

  • The POLST form is designed for:
    • Patients facing life-threatening complications, regardless of age; and/or
    • Patients with advanced frailty and limited life expectancy; and/or
    • Patients who may lose the capacity to make their own health care decisions in the next year (such as persons with dementia); and/or
    • Persons with strong preferences about current or anticipated end-of-life care.

9

slide4

Advance Care Planning Over Time

Maintain and Maximize Health, Choices, and Independence

First Steps:

Complete a PoA. Think about wishes if faced with severe trauma and/or neurological injury.

Next Steps:

Consider if, or how, goals of care would change if interventions resulted in bad outcomes or severe complications.

Last Steps:

End-of-Life plans - establish a specific plan of care using POLST to guide emergency medical orders based on goals.

Document on Power of Attorney form

Document on POLST form

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the polst document

The POLST Document

The POLST Document
  • 3 Primary Medical Order Sections
    • CPR for Full Arrest
      • Yes, Attempt CPR
      • No, Do Not Attempt CPR (DNR)
    • Orders for Pre-Arrest Emergency
      • Full Treatment
      • Limited Treatment
      • Comfort Only
    • Artificial Nutrition and Hydration
      • None
      • Trial period
      • Acceptable

NEW

NEW

NEW

13

section a cardio pulmonary resuscitation
Section “A”: Cardio-Pulmonary Resuscitation

Code Status – applies when breathing AND pulse have stopped

  • There are multiple kinds of emergencies. This section only addresses a full arrest event (no breathing or pulse), and answers “Do we do CPR or not?”
  • NEW! Patients can use this form to say YES to CPR, as well as to refuse CPR.
  • The next section (“B”) addresses other emergencies where the patient is still breathing or still has a pulse.

15

section b medical interventions
Section “B”: Medical Interventions

Do Not Resuscitate does NOT mean Do Nothing

  • Three categories explaining the intensity of treatment when the patient has requested DNR for full arrest, but is still breathing or has a pulse.
    • Comfort – patient prefers symptom management and no transfer if possible
    • Limited – no aggressive treatments such as intubation or mechanical ventilation, but other treatments are OK as expressed on the form
    • Full – all indicated treatments including Intubation and Mechanical Ventilation are acceptable

17

section b medical interventions1
Section “B”: Medical Interventions
  • Use “Additional Orders” for other treatments that might come into question (such as dialysis, surgery, chemotherapy, blood products, etc.), especially if “Limited Additional Interventions” is selected.
  • An indication that a patient is willing to accept full treatment should not be interpreted as forcing health care providers to offer or provide treatment that will not provide a reasonable clinical benefit to the patient (would be “futile”).

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section a choices influence medical interventions in section b
Section “A” choices influence medical interventions in Section “B”

Section A

Section B

Full Treatment

Full Treatment

Yes! Do CPR

*

Comfort Measures

or

*

DNR: No CPR

Limited Interventions

or

*Requires documentation of a “qualifying condition” ONLY when requested by a Surrogate.

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section c artificially administered nutrition
Section “C”: Artificially Administered Nutrition
  • Nutrition by tube can include temporary NG tubes, TPN, or permanent placement feeding tubes such as PEG or J-tubes.
  • A trial period may be appropriate when the benefits of tube feeding are unknown, or when the patient is undergoing other types of treatment where nutritional support would be helpful.
  • Depending on the length of the trial period, providers may want to consider using less invasive forms of tube feeding before deciding on permanent placement options.

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slide12

Requirements for a Valid Form

  • Patient name
  • Resuscitation orders (Section “A”)
  • Patient or Legal Representative signature
  • Witness signature
  • Provider name, signature and date
  • All other information is optional
  • Verbal orders signed by an RN are acceptable
  • Photocopies and faxes ARE acceptable.

43

slide13

Who Can Assist in Preparing a POLST Form?

  • Healthcare providers – “licensed, certified, or otherwise authorized to provide healthcare in the normal course of business.”
  • Best practice suggests use of those trained in the POLST Conversation such as (among others):
    • Physicians
    • Nurses
    • Social Workers
    • Care Managers

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slide14

Take-a-ways

  • Begins now
  • Old DNR will still be accepted. Patients will be asked to fill out new form. So, old and POLST DNR will co-exist.
  • NCH policy on who witnesses POLST forms remain the same as with the current DNR forms. Witnessing the document means one is witnessing the signature
  • DNR policy continues just with a different form
  • If a patient wants medical intervention but is not sure what choices to make, encourage conversation with physician
  • DNR form or POLST is not the same as Advance Directives

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resources

Ethics site on NCH Intranet

National POLST site – www.polst.org

Chicago End-of-Life Care Coalition – www.cecc.info/

NCH Questions:

Spiritual Care Ext. 2010

Gloria Reidinger, Director of Healthcare Ethics @ x7970

Kathy Ferket, Executive Director Patient Care Support @ x7943

Claudette Johnson, Manager of Nursing Support @ x4241

This presentation for the POLST Illinois Taskforce has been made possible by in-kind and other resources provided by POLST Illinois

Resources