A POLST form is a standardized medical document that translates a patient’s preferences for end-of-life care into a set of actionable medical orders. It ensures that the healthcare a patient receives is consistent with their values and goals of care. By documenting specific treatment decisions, the form provides clear guidance for all healthcare providers, including emergency medical personnel, when the patient can no longer communicate their wishes.
The Function of a POLST Form
POLST stands for Physician Orders for Life-Sustaining Treatment, though it may be known by different names such as MOLST or POST in various states. This form carries the weight of a physician’s order, meaning it must be followed immediately by all healthcare professionals. It is a legally binding medical order that travels with the patient across all care settings, including home, hospice, nursing facilities, and hospitals.
The POLST process is intended for individuals with serious, advanced illnesses or frailty for whom death within one to two years would not be surprising. It is not designed for the general healthy population, but for those whose current health status indicates a need for standing medical orders. To ensure quick recognition in an emergency, the form is often printed on a distinctive, highly visible colored paper, frequently bright pink or green. This color coding helps emergency medical services (EMS) and other first responders locate and honor the patient’s wishes without delay.
How POLST Differs from an Advance Directive
The POLST form is frequently confused with an Advance Directive, which includes documents like a Living Will or a Healthcare Proxy, but they serve distinct purposes. The fundamental difference lies in their legal status and applicability. An Advance Directive is a legal document containing general instructions for future care, recommended for all adults regardless of their health status.
Conversely, the POLST form is a medical order signed by a healthcare professional, making it immediately actionable in an emergency. Advance Directives often require interpretation by a designated decision-maker, and emergency responders are typically not authorized to honor them directly. The POLST form, however, is specifically designed to be recognized and honored by EMS personnel.
The target audience also differs significantly. An Advance Directive focuses on future scenarios and appoints a healthcare agent to make decisions if the patient becomes incapacitated. The POLST is focused on immediate medical decisions for individuals with a current, serious life-limiting condition.
Medical Interventions Documented on the Form
The POLST form requires the patient, or their surrogate decision-maker, to make specific choices regarding several life-sustaining treatments. These decisions are organized into mandatory sections that translate preferences into precise medical actions.
The first section addresses cardiopulmonary resuscitation (CPR) status. Here, the patient must choose between “Attempt Resuscitation/CPR” or “Do Not Attempt Resuscitation” (DNAR). A DNAR order directs providers not to perform CPR if the patient’s heart stops or they stop breathing.
The next section details the desired Level of Medical Intervention when the patient has a pulse and is breathing. This section presents a spectrum of care, including “Full Treatment,” “Limited Additional Interventions,” or “Comfort Measures Only.”
Full Treatment generally means utilizing all medically indicated interventions, including intensive care and mechanical ventilation. Limited Additional Interventions focuses on treating medical problems with less aggressive means, often excluding intensive care and intubation. Comfort Measures Only prioritizes pain and symptom management, allowing death to happen naturally without hospitalization for life-prolonging treatments.
A separate section addresses the use of artificially administered nutrition and hydration, such as feeding tubes. The patient can choose to decline all artificial feeding, request a trial period, or opt for long-term use of feeding tubes. These explicit choices ensure that treatment aligns with the patient’s goals of care.
Storage, Review, and Revocation
For the POLST form to be valid, it must be signed by the patient or their legally recognized decision-maker, as well as a qualified healthcare professional (e.g., a physician, physician assistant, or nurse practitioner). Since the POLST is a portable medical order, the original form should be kept in an easily accessible location, such as on the refrigerator or near the front door, so that EMS can find it quickly. A copy is also kept in the patient’s medical record.
The form is not meant to be a static document, and periodic review is recommended, especially when the patient experiences a significant change in health status or transfers between care settings. This review ensures the medical orders continue to reflect the patient’s current condition and preferences.
A patient can change or revoke their POLST form at any time, verbally or in writing, because the form is voluntary. Revocation is accomplished by communicating the desire to revoke to a healthcare provider or by physically destroying the form. If a patient’s wishes change, the healthcare provider must void the existing form and fill out a new one to document the updated orders.