A Physician Orders for Life-Sustaining Treatment (POLST) form is a medical order that translates a patient’s wishes into immediately actionable instructions for any healthcare provider, including emergency medical services (EMS). Unlike an advance directive, which is a legal document outlining general wishes, the POLST is a standing medical order signed by a licensed healthcare professional. This form is designed to ensure that a person’s specific treatment preferences are honored across all care settings, such as their home, a nursing facility, or a hospital. The POLST is a tool for individuals facing serious illness or advanced frailty, providing clarity during a medical crisis when they cannot speak for themselves.
Understanding POLST Eligibility and Preparation
The POLST form is intended for individuals with a serious, progressive illness or advanced frailty, typically those whose healthcare provider would not be surprised if they passed away within the next year or two. This limited focus distinguishes it from an advance directive, which is recommended for all adults regardless of their current health status. The POLST is a state-specific medical order, sometimes known by names like MOLST, POST, or TPOPP, and its implementation is governed by individual state health code provisions.
Before marking any choices, a detailed conversation with a qualified healthcare provider is necessary. This discussion must cover the patient’s prognosis, the potential outcomes of various treatments, and how their personal values align with the medical options presented. The healthcare provider, such as a physician, nurse practitioner, or physician assistant, completes the form based on this shared decision-making process, ensuring the resulting orders are medically appropriate and accurately reflect the patient’s goals of care.
Step-by-Step Guide to Defining CPR Status
The first decision on the POLST form, typically Section A, addresses Cardiopulmonary Resuscitation (CPR) status. This section is relevant only if the patient is pulseless and not breathing, indicating cardiac or respiratory arrest. The two options are “Attempt Resuscitation/CPR” or “Do Not Attempt Resuscitation” (DNR), sometimes labeled “Allow Natural Death.”
Choosing “Attempt Resuscitation/CPR” means full resuscitative measures must be initiated immediately, including chest compressions, mechanical ventilation, and electrical defibrillation. Selecting “Do Not Attempt Resuscitation” means no CPR will be performed in the event of cardiac arrest. Notably, if “Attempt Resuscitation” is chosen, the patient must also select the most aggressive level of care, “Full Treatment,” in the subsequent section on medical interventions.
Selecting the Scope of Medical Interventions
The next major section, usually Section B, outlines the patient’s goals for medical interventions when they are not in cardiac arrest but still require medical attention. This section presents a tiered approach to care, ranging from aggressive treatment to comfort-focused management.
Tiers of Care
The most aggressive choice is “Full Treatment,” which aims to prolong life by all medically effective means. This includes transfer to an intensive care unit (ICU) and the use of mechanical ventilation. “Limited Additional Interventions” or “Selective Treatment” allows for medical treatments such as intravenous fluids and antibiotics to manage reversible conditions, but specifically excludes transfer to the ICU for life-support measures. The third option, “Comfort Measures Only,” prioritizes relief from pain and suffering, limiting medical care to addressing symptoms. Hospitalization is generally avoided unless necessary to achieve comfort.
Specific Treatments
A separate component, often Section C, addresses specific treatments like artificially administered nutrition and hydration, such as feeding tubes. The patient decides whether they want a long-term feeding tube, a time-limited trial, or only oral feeding and hand-feeding for comfort. Decisions regarding antibiotics are also addressed here, allowing the patient to specify whether they want full-course antibiotics for infections or limited use only for symptomatic relief.
Required Signatures and Implementation
For the POLST form to be legally valid and immediately actionable as a medical order, two mandatory signatures are required. The document must be signed by the patient or the patient’s legally authorized decision-maker to confirm informed consent. Critically, a licensed healthcare provider—a physician, nurse practitioner, or physician assistant—must also sign the form. Without the provider’s signature, the document is merely a statement of wishes, not a standing medical order that EMS and hospital staff must follow.
The form also includes a date of completion and should be periodically reviewed, especially when the patient is transferred between care facilities or experiences a significant change in health status. While the form does not expire, a review ensures the orders still reflect the patient’s current wishes and medical condition. For immediate recognition in an emergency, the POLST is typically printed on bright, distinctive paper, often pink or green. The original signed form must travel with the patient and should be stored in an easily accessible location at home, such as on the refrigerator, so first responders can find it instantly.