From the Guidelines
A POLST discussion should document the patient's preferences regarding medical interventions, including their goals of care, values, and quality of life considerations, as well as the treatment options discussed, such as full treatment, limited interventions, or comfort-focused care, as outlined in the most recent study 1. The documentation should include the patient's wishes regarding cardiopulmonary resuscitation (CPR), artificial nutrition, and comfort measures.
- The healthcare provider should record who participated in the conversation, including the patient, family members, and healthcare proxy.
- The patient's decision-making capacity at the time of discussion should be noted, as well as any specific circumstances that might trigger a review of these preferences.
- It is essential to document that the risks, benefits, and alternatives of each intervention were explained to the patient in understandable terms, as stated in 1.
- The healthcare provider should also note any specific concerns or questions raised by the patient or family members and how these were addressed. This comprehensive documentation ensures that the patient's wishes are clearly communicated to all healthcare providers and helps guide treatment decisions during medical emergencies when the patient cannot speak for themselves, ultimately prioritizing their morbidity, mortality, and quality of life outcomes, as emphasized in 1.
From the Research
POLST Discussion Documentation
The following aspects need to be documented as part of a Physician Orders for Life-Sustaining Treatment (POLST) discussion:
- Patient treatment preferences, which should be elicited, communicated, and honored throughout the healthcare system 2
- Orders for life-sustaining treatments, such as cardiopulmonary resuscitation, level of medical intervention, and artificially administered nutrition 3, 4
- Patient or surrogate treatment preferences, although evidence suggests that POLST may not always reflect these preferences 2, 4
- Discussions with patients, family members, and attending physicians to support POLST completion, which can be facilitated through proactive and interdisciplinary approaches 5
- Confirmation that POLST medical orders accurately reflect patients' current values and preferences of care, which may need to be verified frequently 4
Key Components of POLST Forms
POLST forms typically include the following components:
- Cardiopulmonary resuscitation orders
- Level of medical intervention orders
- Artificially administered nutrition orders
- Other life-sustaining treatment orders, which may vary depending on the patient's condition and preferences 3, 4
Importance of Accurate Documentation
Accurate documentation of POLST discussions and orders is crucial to ensure that patient treatment preferences are respected and honored throughout the healthcare system 2, 3, 4. This can help prevent unnecessary or unwanted medical interventions and improve the quality of care for patients with serious illnesses 6.