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Dana M Zive, Jennifer Cook, Charissa Yang, David Sibell, Susan W Tolle, Michael Lieberman
In April 2015, Oregon Health & Science University (OHSU) deployed a web-based, electronic medical record-embedded application created by third party vendor Vynca Inc. to allow real-time education, and completion of Physician Orders for Life Sustaining Treatment (POLST). Forms are automatically linked to the Epic Systems™ electronic health record (EHR) patient header and submitted to a state Registry, improving efficiency, accuracy, and rapid access to and retrieval of these important medical orders. POLST Forms, implemented in Oregon in 1992, are standardized portable medical orders used to document patient treatment goals for end-of-life care...
November 2016: Journal of Medical Systems
Marshall B Kapp
The Physician Orders for Life-Sustaining Treatment (POLST), otherwise known as the POLST paradigm, represents the next generation in end-of-life (EOL) planning for certain patients who wish to exercise prospective control over their own medical treatment in their final days. As is true for any physician treatment orders, a POLST is written in consultation with the patient or patient's surrogate. There are a number of practical impediments to widespread adoption and implementation of the POLST paradigm in medical practice...
2016: AMA Journal of Ethics
Jessica Russell
The Physician Orders for Life-Sustaining Treatment (POLST) is a planning tool representative of an emerging paradigm aimed at facilitating elicitation of patient end-of-life care preferences. This study assessed the impact of the POLST document on provider goals and plans for conversations about end-of-life care treatment options. A 2 (POLST: experimental, control) Ă— 3 (topic of possible patient misunderstanding: cardiopulmonary resuscitation, medical intervention, artificially administered nutrition) experimental design was used to assess goals, plan complexity, and strategies for plan alterations by medical professionals...
September 2016: Journal of Health Communication
Laura Vearrier
The purpose of advance care planning (ACP) is to allow an individual to maintain autonomy in end-of-life (EOL) medical decision-making even when incapacitated by disease or terminal illness. The intersection of EOL medical technology, ethics of EOL care, and state and federal law has driven the development of the legal framework for advance directives (ADs). However, from an ethical perspective the current legal framework is inadequate to make ADs an effective EOL planning tool. One response to this flawed AD process has been the development of Physician Orders for Life Sustaining Treatment (POLST)...
July 8, 2016: HEC Forum: An Interdisciplinary Journal on Hospitals' Ethical and Legal Issues
Joshua R Lakin, Eric Isaacs, Erin Sullivan, Heather A Harris, Ryan D McMahan, Rebecca L Sudore
OBJECTIVE: For patients' preferences to be honored, emergency department (ED) physicians must be able to find and use advance care planning (ACP) information in the electronic medical record (EMR). ED physicians' experiences with ACP EMR documentation and their documentation needs are unknown. METHODS: We surveyed 70 ED physicians (81% response rate) from a tertiary and county ED. Our primary outcome was confidence finding and using ACP EMR documentation (percentage reporting very/extremely on a five-point Likert scale)...
June 2016: Journal of Palliative Medicine
Lee A Jennings, David Zingmond, Rachel Louie, Chi-Hong Tseng, Judy Thomas, Kate O'Malley, Neil S Wenger
BACKGROUND: Physician Orders for Life-Sustaining Treatment (POLST) is a tool that facilitates the elicitation and continuity of life-sustaining care preferences. POLST was implemented in California in 2009, but how well it disseminated across a large, racially diverse population is not known and has implications for end-of-life care. OBJECTIVE: To evaluate the use of POLST among California nursing home residents, including variation by resident characteristics and by nursing home facility...
October 2016: Journal of General Internal Medicine
Samantha Scotti
No abstract text is available yet for this article.
March 2016: NCSL Legisbrief
(no author information available yet)
The medical team found the patient to lack medical decisionmaking capacity. However, the team felt that the patient was still able to respond appropriately to some situations. KS had displayed a consistent refusal of all medical treatments that made her uncomfortable or caused pain. During her sister's visits, the patient would be much more receptive to eating. A meeting was planned with the patient's sister in which the ethicist explained that the patient was not able to make her own decisions. The patient's sister agreed that she would honor the patient's wishes but would let the team make any decisions outside of what she knew about the patient's preferences...
April 2016: Cambridge Quarterly of Healthcare Ethics: CQ: the International Journal of Healthcare Ethics Committees
Bahman Sadeghi, Anne M Walling, Patrick S Romano, Sangeeta C Ahluwalia, Michael K Ong
BACKGROUND: Early discussions about advance care planning (ACP) have been associated with improved patient and caregiver outcomes for patients with serious illness. Many patients with heart failure (HF) may benefit from more timely ACP, in part due to the unpredictable trajectory of the disease. OBJECTIVES: The purpose of this study was to evaluate the feasibility of implementing a multiple-component hospital-based intervention on completion of ACP forms among HF patients...
April 2016: Journal of Palliative Medicine
Pamela Sebastian, Beth Freitas, Daniel Fischberg
A Provider Orders for Life-Sustaining Treatment (POLST) document transforms medical wishes for end-of-life care into actionable medical orders. This study was conducted to assess the extent of POLST implementation amongst nursing facilities in Hawai'i. We performed a telephone survey . The survey instrument included questions about advance care planning processes, POLST training procedures, and implementation of the POLST paradigm. Data were collected in July 2014, the month POLST signatory capacity expanded to include Advance Practice Registered Nurses (APRNs)...
September 2015: Hawai'i Journal of Medicine & Public Health: a Journal of Asia Pacific Medicine & Public Health
Keiran K Tuck, Dana M Zive, Terri A Schmidt, Julie Carter, John Nutt, Erik K Fromme
INTRODUCTION: End-of-life care in Parkinson's Disease (PD) is poorly described. Physician Orders for Life Sustaining Treatment (POLST) forms specify how much life-sustaining treatment to provide. This study aims to better understand end-of-life care in PD using data from the Oregon POLST and Death Registries. METHODS: Oregon death certificates from the years 2010-2011 were analyzed. Death certificates were matched with forms in the Oregon POLST Registry. Descriptive analyses were performed for both the full PD dataset as well as those with POLST forms...
October 2015: Parkinsonism & related Disorders
Keith Wesley, Karen Wesley
No abstract text is available yet for this article.
June 2015: JEMS: a Journal of Emergency Medical Services
Manali I Patel, Jay Bhattacharya, Steven M Asch, James Kahn
OBJECTIVES: To evaluate the documentation of advance directive (ADs) and physician orders for life-sustaining treatment (POLST) with acceptance of palliative care (PC) services referral among patients with cancer. METHODS: We retrospectively reviewed veterans with advanced cancers at the Veterans Administration Palo Alto Health Care System. Chi-square tests estimated AD and POLST documentation and referral to PC. Logistic regression models estimated the odds of AD and POLST documentation and PC referral...
September 2016: American Journal of Hospice & Palliative Care
Dana M Zive, Erik K Fromme, Terri A Schmidt, Jennifer N B Cook, Susan W Tolle
CONTEXT: The physician orders for life-sustaining treatment (POLST) paradigm allows health care professionals to document the treatment preferences of patients with advanced illness or frailty as portable and actionable medical orders. National standards encourage offering POLST orders to patients for whom clinicians would not be surprised if they died in the next year. OBJECTIVES: To determine the influence of cause of death on the timing of POLST form completion and on changes to POLST orders as death approaches...
November 2015: Journal of Pain and Symptom Management
(no author information available yet)
A new study suggests there is a lack of consensus or understanding about what patients intend when they fill out Physicians Orders for Life Sustaining Treatment (POLST) forms, and that this likely leads to patients either receiving or not receiving treatment contrary to their wishes. Investigators suggest more training on these issues is needed, and recommend that clinicians take the time to clarify choices during periods of critical illness. A new study found that when presented with a range of clinical scenarios coupled with POLST forms reflecting patient wishes, emergency providers did not often reach a consensus on what actions they would take...
June 2015: ED Management: the Monthly Update on Emergency Department Management
Anna N Rahman, Matthew Bressette, Zachary D Gassoumis, Susan Enguidanos
PURPOSE OF THE STUDY: Previous studies examining preferences documented in Physician Orders for Life Sustaining Treatment (POLST) have found that most sampled POLSTs show a preference to limit care. These studies were conducted in states that are relatively ethnically homogeneous. This study investigated the POLST preferences of nursing home residents in an ethnically diverse state-California-that requires nursing homes to document whether residents execute POLST. DESIGN AND METHODS: Data were collected from POLST forms executed by 941 residents in a convenience sample of 13 nursing homes in Southern California...
August 2016: Gerontologist
Hyejin Kim, Mary Ersek, Christine Bradway, Susan E Hickman
PURPOSE: Many nursing home (NH) residents with dementia receive burdensome, aggressive treatments at the end of life (EOL). The Physician Orders for Life-Sustaining Treatments (POLSTs) paradigm is a strategy to enhance EOL care. This article describes the history and features of the POLST paradigm, discusses the potential advantages of using this paradigm for NH residents with dementia, and briefly explores challenges that nurse practitioners (NPs) face in using the POLST for persons with dementia...
November 2015: Journal of the American Association of Nurse Practitioners
Joseph E Ibrahim, Aleece MacPhail, Margaret Winbolt, Phil Grano
The prevalence of dementia is growing with an ageing population. Most persons with dementia die of acute illness and many are hospitalised at the end of life. In the acute hospital setting, limitation of care orders (LCOs) such as Do Not Attempt CPR and Physician Orders For Life Sustaining Treatment (POLST), appear to be underused in patients with dementia. These patients receive the same aggressive life-prolonging therapies as any other patient, despite drastically higher mortality. However, limitation of care orders in patients with dementia is not addressed by current guidelines or policies...
January 2016: Resuscitation
Ferdinando L Mirarchi, Christopher Cammarata, Samuel W Zerkle, Timothy E Cooney, Jason Chenault, David Basnak
BACKGROUND: Physician Orders for Life-Sustaining Treatment (POLST) documents are medical orders intended to honor patient choice in the hospital and prehospital settings. We hypothesized that prehospital personnel will find these forms confusing. OBJECTIVES: The aim of this study was to determine whether POLST documents accord consensus in determining code status and treatment decisions among emergency medical services providers on the basis of an Internet survey...
March 2015: Journal of Patient Safety
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