The Role of POLST in Advance Care Planning End-of-Life Principles - - PowerPoint PPT Presentation

The Role of POLST in Advance Care Planning

End-of-Life Principles

End-Of-Life Care Is About:

• Compassion at the bedside
• Providing comfort
• Honoring patients’ preferences

Advance Care Planning

"Advance Care Planning Is Not An Event, It's A Process." * * Susan Tolle, director of the Center for Ethics in Health Care at Oregon Health & Science University

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Gold Standard

Discussing and following a patient’s preferences for end-of-life care should be as routine as asking about and responding to a patient’s allergies to medicines

Advance Care Planning

Discussion Decision Documentation

Right to Refuse Medical Treatments

• In Georgia, a competent adult has the right to

refuse any unwanted medical treatment for any reason

• Right to refuse medical treatments includes life

support and other life-sustaining treatments

• The right to refuse or terminate treatments may

be exercised by family members or loved ones

Advance Care Planning Tools

• Georgia Advance Directive for Health Care
• Georgia Physician Order for Life Sustaining

Treatments (POLST)

• Wellstar “Tool Kit” / Education Packet

Georgia Advance Directive for Health Care

One document for all health care preferences

• Naming a health care agent / authorized person
• Stating treatment preferences
• Authorizing organ donation
• Pt. Signature & 2 Witnesses

Georgia POLST

• Medical order completed by a health care

provider

• Activates a patients Advance directive
• Mechanism to communicate a patient’s

wishes for their care at the end of their lives

• Designed to travel with patient from one care

setting to another

Who Should Have a POLST?

• Anyone who might die within the next year
• Anyone with an advanced chronic condition
• Anyone choosing “Allow Natural Death”/DNR
• Anyone residing in a long term care facility

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Georgia POLST Form

• Developed by the Georgia Department of

Public Health in 2012 pursuant to Official Code of Georgia Section 29-4-18(l)

• Available at www.dph.ga.gov/POLST
• Use and compliance with POLST form

provides immunity to any “person” acting in good faith

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Georgia POLST Form

Five Sections

• Cardiopulmonary Resuscitation
• Medical Interventions
• Antibiotics
• Artificially Administered Nutrition
• Signatures

POLST Conversation

• POLST is not just a check-box form
• The POLST conversation provides context for

patients/families to: ⁻ Make informed decisions ⁻ Identify goals of treatment

• A patient or their Health Care Agent can request

alternative treatment or revoke a POLST at any time

End-of-Life Documents Are Activated

When, in the judgment of the physician, one of “three conditions” are met:

• Patient is in the last year of their life / a Terminal

Condition

• Patient is in a permanent state of unconsciousness
• Medical judgment that CPR would be inappropriate

Healthcare Agent / Authorized Person

Responsibilities:

• To follow the patient’s known preferences
• To honor the patient’s Advance Directive and

POLST

• To act in the best interest of the patient

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Healthcare Team

Responsibilities:

• To follow the patient’s known preferences
• To honor the patient’s Advance Directive and

POLST without regard to personal views

• If unable to honor preferences, facilitate the

transfer of patient’s care

“Getting it Right”

• Honor all patients wishes
• Encourage all patients to have an Advance

Care Plan

• Utilize POLST when patient condition applies
• Apply reasonable medical judgment

Georgia POLST Collaborative

• 30+ Statewide Organizations
• Part of a national movement to promote

POLST

• Endorsed by the National POLST Paradigm

Taskforce

• Vision:

All Georgians will have their health care preferences known and honored

Georgia POLST Collaborative

• Mission:

To improve healthcare at the end-of-life through 1) Promoting the utilization of the POLST form by health care professionals and institutions across the state and 2) Educating Georgians about advance care planning and the role of POLST in having their wishes honored.

“Conversation Project”

an effort led by veteran Boston journalist Ellen Goodman and launched in August 2012 with backing from the Institute for Healthcare

• Improvement. Goodman says 60,000 people

have visited www.theconversationproject.org, and 40% of them have downloaded a conversation-starter kit.

“Conversation Project”

Goodman, who launched her project after a difficult experience caring for her own dying mother, says, "What we really need is to change the cultural norm from not talking about it to talking about it."

“Let’s Have Dinner and Talk About Death”

• Michael Hebb
• TED Talk
• “Death Over Dinner.org
• Three Question
• What do we want our final days to look like?
• Who do we want to be nears us?
• How can we support the E-O-L wishes of those

closest to us?

Keys

• Choose a medical decision-maker
• Decide what matters most in life
• Flexibility for your decision-maker?
• Tell others about your wishes
• Ask doctors and lawyers the right questions

POLST Websites

• Critical Conditions Planning Guide
• www.critical-conditions.org
• www.gapolst.org
• www.dph.ga.gov/POLST
• www.polst.org
• www.capolst.org/documents/POLSTFAQ

Thank You