Somewhere between Advanced Directives, Durable Do Not Resuscitate and a patient’s wishes is a gray area about end-of-life patient care. A program begun on the west coast helps caregivers identify and honor those end-of-life wishes. That program, with its Virginia roots in the Roanoke area, is called POST or Physician Orders for Scope of Treatment. The program was piloted by Sentara in part of the Tidewater EMS region during 2011 and 2012, and will roll out regionwide, as well as in several other parts of Virginia, starting October 1, 2012.
The Physician Orders for Life-Sustaining Treatment (POLST) Paradigm program is designed to improve the quality of care people receive at the end of life. It is based on effective communication of patient wishes, documentation of medical orders on a brightly colored form and a promise by health care professionals to honor these wishes. The program acronym can and does change from state-to-state. In Virginia, the program is known as POST.
The POST form has been determined by the Virginia Office of EMS to be an acceptable substitute for the DDNR form. EMS providers can honor the Section A of the form which identifies Do Not Resuscitate wishes.
The EMS role with POST:
- Know what the POST form looks like.
- Know location of POST form in transfer records.
- Honor DDNR (SECTION A).
- During transfer to a hospital, communicate to medical control that patient has a POST form and the contents of Section A and B.
- At receiving facility, communicate that patient has a POST form and its location.
- Document turnover of POST Form.
- During transfer to a nursing/residential facility, ask if a POST form is available and transport it with the patient.
Differing from DDNR, POST can list additional medical interventions desired by a patient. Those interventions, intended to convey patient wishes to hospital and facility medical staff, are generally grouped into three levels:
1. comfort measures only (usually with no hospital admission)
2. limited intervention (possible hospital transport but no ICU)
3. Full treatment (including ICU care)
Each level is slightly more detailed than this list, providing a menu of end-of-life choices within each level.
Studies have shown that POLST experience elsewhere is associated with decreased hospitalizations at the time of death, but to be effective it needs to be integrated into the healthcare and hospital system and included in regular healthcare provider training, including EMS.
General information about this topic can be found at the website www.polst.org.