MI-POST The EMS Perspective Michigan History National movement - - - PDF document

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MI-POST

The EMS Perspective

Michigan History

National movement - The POLST Paradigm 2004 (was local in a few other states before that) Honoring Healthcare Choices MI

• MI-POST Pilot Program
• 2012 – 2015
• EMS participated through Special Study

Legislation introduced in 2017

Michigan History

Public Act 154 of 2017 was signed into law on November 8, 2017 by Governor Snyder

• Intent to assist health care professionals honor the treatment wishes of individuals at end of life
• Creates a system to communicate wishes regarding medical treatment through portable medical orders
• Based on the principles of informed consent
• Creates portable medical orders
• Dovetails with the national POLST Paradigm movement

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Public Act 154 of 2017:

Enacts MI-POST Portable medical orders binding in all health settings

• Advisory in acute care settings

For frail elders or others who may face end of life in the next 12 months Signed by Patient or Patient Advocate/Representative and Provider Always voluntary Valid for 1 year, but may be revoked or revised at any time Rules for digital or electronic copies

MI-POST vs Advance Directive

MI-POST is a portable, valid medical order that identifies what care to provide in the case of medical crisis. It is the culmination of advance care planning activities between a patient and provider Advance Directives/Durable Power of Attorney for Healthcare identify who may speak for the patient if they are not able to speak for themselves

MI-POST General Rules

MI-POST is ONLY for individuals with an advanced illness nearing end of life (12 months or less) MI-POST can not be required for admission to any healthcare setting or agency Standard form is printed on pink card stock Original form in its most current version remains the property of the patient – BUT OTHER VERSIONS COUNT

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Signatures:

MI-POST must be signed to be valid

• Patient or activated Patient Advocate/Representative
• Attending Health Professional – Physician, Physician Assistant, or Nurse Practitioner

MI-POST is valid for one year following signing Verbal/Telephone orders are acceptable as defined by organizational policy

Rules for Reaffirming or Revoking

MI-POST must be reaffirmed in the following circumstances:

• One year from the date last signed or reaffirmed
• 30 days from a change in attending health professional
• One week from a change in care setting or unexpected change in medical condition

MI-POST may be revoked by the Patient or Patient Advocate/Representative at any time Changes in desired choices requires completion of a new form with the new choices indicated Write Revoked across the signatures on the form Write VOID across both sides of the form Reasonable action taken to notify the attending health professional

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DNR Box – ONLY USE IF THE PERSON IS IN ARREST Comfort-Focused Treatment – primary goal of maximizing comfort. Selective Treatment – goal of treating medical conditions while avoiding burdensome measures. Full Treatment – primary goal of prolonging life by all medically effective means. Additional Orders – As written – Physician Orders

Rules for EMS

Signed by patient/patient advocate and attending health professional Most recent set of signatures is <1 year old Any blank section implies full treatment. If it isn’t marked, you do everything If it meets criteria, the copy counts (digital, paper, etc) The patient or patient advocate can revoke at ANY time Comfort measures DOES NOT EQUAL DO NOTHING

Rules for Conflicts

A properly executed MI-POST is presumed to express the patient’s current wishes over a previously executed advance directive If a MI-POST form has been executed after a Do-Not-Resuscitate order is executed under the Michigan Do-Not-Resuscitate Procedure Act (1996 PA 193), the MI-POST is presumed to reflect the patients most current wishes THE MOST RECENT DATED LEGAL DOCUMENT IS THE ONE YOU FOLLOW

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What’s the hang up?

• POST and components moved to MDHHS Policy and Legislative Affairs
• Website
• Rule Promulgation
• Interpretation Discrepancy with legislation

Questions?