Frequently Asked Questions by Health Care Professionals
What is POLST?
The POLST Paradigm is a clinical process designed to facilitate communication between health care professionals and patients with serious advanced illness or frailty (or their authorized surrogate) where the health care professional would not be surprised if the patient died within the next year. The process encourages shared, informed medical decision-making leading to a set of portable medical orders that respects the patient’s goals for care in regard to the use of cardiopulmonary resuscitation (CPR) and other medical interventions, is applicable across health care settings, and can be reviewed and revised as needed.
Is POLST Required?
Completion of POLST Forms should never be mandatory. Facilities may have policies requiring certain patients be offered the opportunity to have the conversation and complete one, but completion of a POLST Form should always be voluntary.
There is also value in the process of having a POLST Conversation- even if a POLST Form is not completed as a result of the conversation, the process allows patients to have better awareness of their options for treatment going forward and health care professionals to better understand their patient’s goals of care.
Why was POLST created?
As patients become older and frail, or are diagnosed with a serious advanced illness, not all are interested in receiving the highest levels of treatment, which is the current standard of care. The POLST Form was developed and tested by Oregon clinical ethics leaders who recognized that preferences for life-sustaining treatments of patients, usually documented in advance directives, were frequently not found, too vague, or not transferable, and therefore not honored. They created a new method of translating patient preferences into actionable medical orders that, unlike an advance directive, is based on informed, shared decision-making between a patient and his/her health care professional that provides clear guidance to emergency personnel in a format that is easily located and portable across care settings. The POLST process, the conversation and form, helps ensure patient wishes are elicited, documented and honored, which improves patient care and reduces medical errors.
When should I offer a patient a POLST Form?
POLST Forms should be offered to patients who have serious advanced illness or frailty and their health care professional would not be surprised if they died within the year.
Who Completes and Signs the POLST Form?
The POLST Form is a medical order and must be signed by a physician, nurse practitioner or physician assistant to be valid. Patients or their surrogates should be encouraged to sign, but the form is legally valid without their signature.
How do I Void a POLST Form?
A patient with capacity (or his/her surrogate if the patient lacks capacity) can void the form at any time. A line should be drawn through all sections of the form and the word “VOID” should be written in large letters if the POLST Form is updated or voided. A copy of the voided POLST Form must be sent to the Oregon POLST Registry (with the updated POLST if applicable) if the patient did not opt out of the Registry.
How do I Update a POLST Form?
POLST Forms should be reviewed periodically and updated if:
- the patient is transferred from one care setting or care level to another (including upon admission or at discharge; or
- there is a substantial change in the patient’s health status.
How do I Use a Non-English POLST Form?
The POLST form is read by emergency medical personnel, nurses, and physicians who may speak only English. In order for POLST Forms to be portable, they must be in English. However, a Spanish form is available to help explain the orders to Spanish speaking persons, but the only form that is valid to be used in the field is in English version.
Can a Surrogate be Appointed Using the POLST Form?
No. Only an advance directive may be used to appoint a surrogate in Oregon.