In the face of a quickly growing national POLST movement, we should perform more research as it relates to patient safety and provider understanding. Medical providers need to embrace POLST but be aware of its limitations. One should consider guidelines from the American Bar Association and National POLST Paradigm Task Force regarding reviewing and confirming choices elected on POLST forms.10 The use of a patient-safety checklist would be a conservative approach to individualize patient care and safety. A resuscitation pause or advance directive patient-safety checklist (see Table 1) represents an opportunity to maintain compliance with existing national recommendations and also help ensure the delivery of appropriate care.7,8,11,12
Dr. Mirarchi is medical director of the department of emergency medicine at UPMC Hamot and chair of the UPMC Hamot Physician Network in Erie, Pennsylvania.
References
- Hickman SE, Nelson CA, Perrin NA, et al. A comparison of methods to communicate treatment preferences in nursing facilities: traditional practices versus the physician orders for life-sustaining treatment program. J Am Geriatr Soc. 2010;58:1241-1248.
- California Advocates for Nursing Home Reform. Physician orders for life sustaining treatment (“POLST”): problems and recommendations, 2010. Available at: http://www.canhr.org/reports/2010/POLST_WhitePaper.pdf. Accessed April 9, 2014.
- Fromme E, Zive D, Schmidt T, et al. Association between physician orders for life-sustaining treatment for scope of treatment and in-hospital death in Oregon. J Am Geriatr Soc. 2014;62(7):1246-1251.
- Richardson DK, Fromme E, Zive D, et al. Concordance of out-of-hospital and emergency department cardiac arrest resuscitation with documented end-of-life choices in Oregon. Ann Emerg Med. 2014;63:375-383.
- Schmidt TA, Zive D, Fromme EK, et al. Physician orders for life-sustaining treatment (POLST): lessons learned from analysis of the Oregon POLST registry. Resuscitation. 2014;85:480-485.
- Nicholas LH, Langa KM, Iwashyna TJ. Regional variations in the association between advanced directives and end-of-life Medicare expenditures. JAMA. 2011;306:1447-1453.
- Mirarchi FL, Doshi AA, Zerkle SW. TRIAD VI–how well do emergency physicians understand physicians orders for life-sustaining treatment (POLST) forms? J Patient Safe. 2015;11:1-8.
- Mirarchi FL, Cammarata C, Zerkle SW. TRIAD VII–do prehospital providers understand physicians orders for life-sustaining treatment documents? J Patient Safe. 2015;1:9-17.
- Mirarchi FL, Costello E, Puller J, et al. TRIAD III: nationwide assessment of living wills and do not resuscitate orders. J Emerg Med. 2012;42:511-520.
- National POLST Paradigm Task Force. POLST legislative guide. Available at: http://www.polst.org/wp-content/uploads/2014/02/2014-02-20-POLST-Legislative-Guide-FINAL.pdf. Accessed May 16, 2014.
- Mirarchi FL. Avoid potential pitfalls of living wills, DNR, and POLST with checklists, standardization. ACEP Now. 2014;33:13.
- Mirarchi FL. A new nationwide patient safety concern related to living will, DNR orders and POLST-like documents. October 2014. Available at: http://www.npsf.org/blogpost/1158873/200782/A-New-Nationwide-Patient-Safety-Concern-Related-to-Living-Wills-DNR-Orders-and-POLST-Like-Documents. Accessed April 15, 2015.
- Mirarchi FL. Understanding Your Living Will. Omaha, Neb: Addicus Books; 2006.
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One Response to “Physician Orders for Life-Sustaining Treatment Paradigm Has Pitfalls”
June 12, 2015
Jo Kline Cebuhar, J.D.I believe Dr. Mirarchi’s own research and the other issues relating to the management of critical and end-of-life care that he addresses clearly demonstrate that the key to giving care that respects the patient’s preferences as well as the realities of our health care system is all about EDUCATION and COMMUNICATION. No single form–Living Will, Durable Power of Attorney for Healthcare or POLST–can, in and of itself, substitute for meaningful physician/patient/proxy conversations. Identifying patient goals and engaging in constructive and timely shared decision making is the answer–not another one-size-fits-all form. Keep up the good work, Dr. Mirarchi!
Jo Kline Cebuhar, J.D.
author of
2015 Edition
The practical guide to
Health Care Advance Directives