A POLST document is used in advance care planning to ensure the medical wishes of seriously ill or frail patients are honored in an emergency. The acronym stands for Physician Orders for Life-Sustaining Treatment, though the name can vary slightly by state, sometimes appearing as MOLST or POST. This form translates a patient’s preferences regarding life-sustaining medical treatments into a set of immediately actionable, portable medical orders. It is specifically intended for individuals facing a serious illness or advanced frailty. The goal is to prevent unwanted or medically ineffective treatments and ensure consistency across all healthcare settings.
Defining the Document and Its Purpose
A POLST is a standardized, single-page document that functions as an out-of-hospital medical order. It is often printed on brightly colored paper, such as pink or green, so it is instantly recognizable by emergency personnel and facility staff. This form must be completed and signed by a qualified healthcare provider, such as a physician, nurse practitioner, or physician assistant, to be legally valid. Its purpose is to guide immediate care during a medical crisis when a patient is unable to communicate their wishes.
The form is portable, meaning it travels with the patient and must be followed by emergency medical services (EMS) and healthcare professionals in any setting, including home, hospital, or nursing facility. It results from a detailed conversation between the patient, or their authorized decision maker, and the healthcare team about the patient’s goals of care. This process ensures the patient’s current health status and preferences are accurately reflected.
Distinguishing POLST from Advance Directives
The POLST document is frequently confused with an Advance Directive, but they serve different functions and audiences. Advance Directives are legal documents recommended for all competent adults, regardless of health status, and they communicate general wishes for future medical care. They often appoint a surrogate decision maker to speak on the patient’s behalf if they become incapacitated.
In contrast, the POLST is a set of medical orders reserved for people with serious illnesses and contains specific, actionable instructions for immediate medical interventions. Emergency medical technicians (EMTs) are legally obligated to follow the orders on a valid POLST form, but they cannot honor the general preferences or the surrogate appointment found in an Advance Directive. The POLST complements the Advance Directive rather than replacing it, acting as a direct translation of the patient’s wishes into concrete medical commands. If a conflict exists between the two documents, the more recently completed document generally takes precedence regarding the area of disagreement.
Key Treatment Decisions Covered
The POLST form organizes treatment preferences into specific categories for immediate medical attention. The first decision concerns Cardiopulmonary Resuscitation (CPR) status, allowing the patient to choose either to attempt resuscitation or to have a Do Not Resuscitate (DNR) order. The form then addresses the desired Level of Medical Intervention, offering choices such as “Full Treatment,” “Limited Additional Interventions,” or “Comfort Measures Only.” Full treatment includes aggressive measures like intensive care unit (ICU) care and surgery, while comfort measures focus solely on pain and symptom relief.
The form also requires an explicit decision regarding Artificial Feeding, covering the use of tube feeding or other forms of medically prescribed nutrition and hydration. Preferences for other life-sustaining support, such as antibiotics or intravenous fluids, are also documented as binding medical orders.
Implementation, Review, and Revocation
For the POLST document to be valid, it must be signed by the patient, or their legally recognized decision maker, and a qualified healthcare professional. The original form should remain with the patient at all times, often kept in an easily visible location, such as on the refrigerator, so first responders can locate it immediately. Faxed or copied versions are also considered valid.
The POLST is not a permanent directive and should be reviewed periodically to ensure it reflects the patient’s current health status and wishes. Review is important when the patient transfers care settings or experiences a significant change in medical condition. A patient with decision-making capacity can change or revoke the POLST at any time, often by communicating the decision to a healthcare provider or by writing “VOID” across the document. Validity and revocation requirements are governed by state laws.