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December 2, 2019

The Physician Order for Life-Sustaining Treatment (POLST) Form and Its Use

Wes Luckey, Deputy Director

The POLST form was developed in 1992 and is a physician order for how emergency medical personnel shall clinically respond to a patient at the site of an injury or illness. At GCACH's November Leadership Council meeting, Dr. Wayne Kohan, medical director for Chaplaincy Health Care, discussed the use of the POLST. The form outlines treatment of the individual and can curtail futile emergency medical treatment at the patient’s request. In essence, it summarizes the patient’s wishes that may have been identified in other advance directive documents (e.g. Health Care Directive or Durable Power of Attorney for Healthcare). The POLST may allow for a natural death in certain circumstances, should the patient request this in writing. The form is meant to be portable and follows the patient from one healthcare setting to another. 
 
The POLST contains four major sections:
  1. Cardiopulmonary Resuscitation: This section simply states whether or not to apply CPR in an emergent situation. The current default standard of care is that everyone receives CPR. However some patients, for example those with advanced illness, may opt not to receive it when they are in a hospital.
  2. Medical Interventions: Options here include whether the patient prefers Full Treatment (e.g. intubation), Selective Treatment (e.g. do not intubate, IV, medication) or Comfort-Focused Treatment (e.g. pain medication only).
  3. Use of Antibiotics: Antibiotics may be selected for either prolonging life or for symptom management.
  4. Medically Assisted Nutrition: The four options here include the optional use of nutrition by tube.
Completing the POLST takes careful planning and should be done in partnership with the clinician, the patient and patient’s family. By doing this, it eases the burden on the family or caregiver during an emergency situation. While the POLST is most important when you are nearing the end of life, it should also be coupled to other legal documents, include the Durable Power of Attorney for Healthcare. Anyone over 65 or has a serious life-limiting illness should consider this. As well, the Bree Collaborative has recommended increasing awareness of advance care planning, advance directives, and POLST in Washington State.