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POLST Is More Than a Code Status Order Form: Suggestions for Appropriate POLST Use in Long-Term Care.

Susan E Hickman1, Karl Steinberg2, John Carney3

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Journal of the American Medical Directors Association
|May 24, 2021
PubMed
Summary

Physician Orders for Life-Sustaining Treatment (POLST) forms are misused in nursing homes as a default for all residents, not just those with serious conditions. This practice poses risks and requires careful implementation to ensure appropriate use for end-of-life care decisions.

Keywords:
Advance care planningPOLSTcode statusnursing home

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Area of Science:

  • Geriatric Medicine
  • Medical Ethics
  • Healthcare Policy

Background:

  • Physician Orders for Life-Sustaining Treatment (POLST) forms document patient preferences for life-sustaining interventions.
  • POLST paradigms are widely adopted across states, often under variations like POST, MOLST, and MOST.
  • These forms are crucial for geriatric patients with serious life-limiting conditions.

Purpose of the Study:

  • To examine the reasons behind the default use of POLST forms in nursing homes.
  • To identify the risks associated with the inappropriate application of POLST orders.
  • To provide recommendations for the appropriate utilization of POLST in residential care settings.

Main Methods:

  • Review of current practices in nursing homes and residential care settings.
  • Analysis of the potential risks of POLST misuse in non-eligible patients.
  • Development of guidelines for appropriate POLST implementation.

Main Results:

  • POLST forms are sometimes used as a default "code status" order for all residents, irrespective of their health status.
  • This default usage can lead to inappropriate medical orders for patients who are not candidates for POLST.
  • Risks include the potential for unwanted interventions and misaligned end-of-life care.

Conclusions:

  • Nursing homes should avoid using POLST as a blanket order for all residents.
  • Appropriate patient selection is critical for the ethical and effective use of POLST.
  • Implementing clear guidelines can prevent the misuse of POLST and ensure patient wishes are respected.