POLST - 3 Lesser Known Strategies for Success

Delaware Academy of Medicine

It was a pleasure to be a part of a well-attended and well-engaged conference on DMOST (Delaware POLST) yesterday.  



David Barile's presentation was particularly polished and engaging.  But for those who work with advance care planning issues, much of the content from most presenters was familiar.  Like hand washing, the lessons are known.  The real challenge lies in effective implementation.  So, I will briefly describe just three lessons that I think have received comparatively little attention.



1.  The New Jersey POLST, in contrast to every other state, has the orders for CPR/DNR in section 'D' instead of at the top of the form.  In light of Fred Mariarchi's research on how DNR orders are widely misinterpreted (which I review here), this seems like a prudent move.  Furthermore, the top of the form records "goals of care," making the form a useful decision aid and not just an order set.



2.  Since patients and residents may be unfamiliar with POLST, it is useful to direct them to videos an other decision aids in advance of a meeting to complete a POLST.  This is already where informed consent is moving for much of the rest of medicine.   



3.  Since POLST is such an effective tool and mechanism for assuring that patient preferences are known and honored, it will soon be negligent to not use POLST.  POLST is now well-established or being implemented in 45 states.  To sit idly by would be like manufacturing a car in 2013 without seat-belts or airbags.