Physician Orders for Life-Sustaining Treatment (POLST): How Do Nursing Facilities Implement the POLST Program?

The Physician Orders for Life-Sustaining Treatment (POLST) is a novel end of life advance planning tool. In form, the POLST is a medical order. However the document is completed before the onset of a medical crisis, and can be used by patients to direct medical treatment much like a living will. End-of-life care is an important public health concern, and it is hoped that the POLST will give individuals greater control over their medical care. I surveyed 19 nursing homes using the POLST form in one Pennsylvania county to determine whether the POLST is being implemented in the way intended by its designers. The survey asked whether the POLST is presented to residents as required, recommended, or optional; whether the POLST is offered to all nursing home residents or only certain types of residents; whether the facility requires a patient or surrogate signature on the form; whether the facility updates the form at resident care conferences or upon a change in medical condition; whether the facility screens the POLST for errors and makes sure it is signed by an appropriate medical professional before it is put into the chart; and how much time it typically takes to complete a POLST for residents with and without a living will. The survey also asked whether facilities were complying with state law procedural requirements for end-of-life decision making when using the POLST. The survey found that most nursing facilities reported that they present the form as being required, and they offer it to all residents regardless of medical condition. Approximately half of the facilities follow the recommendation of the National POLST Paradigm Task Force to obtain a resident or surrogate signature on the POLST. Almost all respondents said they typically complete a POLST for a resident who does not have a living will in less than an hour. Most facilities update the form upon a change in medical condition and check the form for errors. Many of the surveyed nursing homes are not complying with procedural requirements of state law when using the POLST to implement decisions regarding end-of-life medical treatment