What is POLST?
In North Dakota, POLST stands for Physician Order for Life Sustaining Treatment. It is a signed medical order that communicates the patient’s wishes for emergency treatment when a person faces serious illness, frailty, or end of life. (Note, the term patient is also intended to include the patient’s healthcare agent or surrogate decision maker. The term, provider includes those with prescriptive practice- physician, nurse practitioner, clinical nurse specialist or physician assistant).
How does it differ from a Healthcare Directive?
| Healthcare Directive | POLST form | |
| Population | All adults >18 y.o. | Any age, serious illness, at end of life or frailty |
| Time Frame | Future care/future conditions | Current care/current conditions |
| Where Completed | Any setting, not necessarily medical | Medical setting |
| Resulting Product | Healthcare agent appointed and/or statement of preferences | Medical orders based on shared decision making |
| Healthcare Agent Role | Cannot complete | Can consent if patient lacks capacity |
| EMS Role | Does not guide EMS | Guides EMS as a medical order |
| Portability | Patient/family responsibility | Healthcare professional responsibility |
| Periodic Review | Patient/family responsibility | Healthcare professional responsibility |
Who completes and signs the POLST form?
The conversation and form can be started by any healthcare professional (nurse, social worker, chaplain, doctor) but must be reviewed, completed, and signed by a patient’s health care provider (doctor, nurse practitioner, physician assistant) after he/she discusses life-sustain treatment options with the patient and the patient selects a treatment plan. Once the form is filled out, the provider and patient (or healthcare agent) sign and date the form. The patient keeps the original. Copies, like Healthcare Directives, are provided for the hospital and family members. A POLST form is not valid unless signed by a health care provider.
Who should have a POLST conversation and form?
Patients with serious health conditions who need to make decisions about life sustaining treatment in advance of medical emergencies should have a POLST conversation and form. The POLST form is recommended even for patients who have a healthcare directive, because it provides greater detail as to the provision for emergency care of the patient.
Where is the POLST form stored?
The original POLST form (with green trim) is intended to travel with the patient between care settings including the patient’s home, long term care facility or hospital. It should be kept in a place where emergency responders can find it (the refrigerator door if the patient lives in a house or in a chart of a hospital or nursing home if the patient is there). Ideally this form will also be kept as part of a patient’s electronic medical record.
How often should a POLST form be Reviewed and or Replaced?
The POLST form should be reviewed each time the patient is transferred from one care setting or level to another, or when there is a substantial change in the patient’s health status. A patient can request a change ANY TIME. A new POLST form should be completed when the patient’s treatment preferences change. There is no expiration date on the POLST form.
How can a POLST form be voided?
A POLST form can be voided at any time by the patient:
- At the direction of the patient. The provider is instructed to revoke or fill out a new form, or
- The patient draws a line through some or all the POLST form and writes VOID in large letters
- The patient intentionally destroys the POLST form-tears or burns the form.
Where can I find individual directions for the sections of the POLST form?
Directions on how to fill out the POLST form are located on the backside of the form. Providers should familiarize themselves with the directions prior to using the form with patients.
Is the POLST form valid in North Dakota?
Although the original Altru POLST form from 2007 has been used in isolated areas for several years, the new 2016 ND POLST form is available. Education and policy development is being review under Honoring Choices® North Dakota’s medical director and POLST workgroup.
For further questions, contact Nancy Joyner, Honoring Choices® North Dakota POLST coordinator at nancy.joyner@honoringchoicesnd.org or by phone at (218) 779-5037.