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Quality of life at the end of life

Oregon POLST Adjusts To Digital Shift

polst-largeAn Oregon medical order designed for patients nearing death is evolving to better complement the state’s shift towards electronic record keeping.

ePOLST is the fully integrated electronic version of Physicians Orders For Life-Sustaining Treatment, or POLST form. They are more detailed than conventional living wills or advance health care directives – these medical orders extend patients the freedom to indicate preferences regarding hospitalization, resuscitation, intravenous antibiotics and duration of feeding tubes.

In emergency situations, first responders are trained to look for the form in the patient’s home, purse or briefcase. Unfortunately, sometimes care providers are unable to locate the document or forget to ask for it. In hospitals, such forms are often illegible after being faxed.

ePOLST is designed to make sure no patient with a completed form ever receives unwanted treatments by more accurately recording and storing them. The initiative is a collaboration between Oregon POLST, Oregon Health & Science University and Silicon Valley startup, Vynca.

OHSU clinicians can now view a patient’s POLST at the top of his or her electronic health record. They will soon be able to electronically search the Oregon POLST Registry through ePOLST, which will hopefully make it easier to find forms from other health care systems.

Paper forms will still be honored, but the current statewide error rate for paper POLST forms submitted is nearly 20 percent, according to the Oregon POLST Registry.

Susan Tolle via YouTube

Susan Tolle via YouTube

“We want to ensure that patient wishes, to have or to limit treatment, are honored in every step of the process of transition from one setting to another,” said Dr. Susan Tolle, director of the Center for Ethics in Health Care and chair of the Oregon POLST Task Force. “It’s imperative that these important orders be found quickly and available in every context.”

The program was developed in Oregon the 1990s to help ensure the wishes of terminally ill patients nearing death are followed by physicians and emergency responders. POLST programs have since been adopted or are in development in 43 states across the nation, as well as in five countries.

POLST is divided into basic sections – CPR, medical interventions and artificial nutrition. Medical providers are required to follow patients’ preferences as they are indicated on signed forms. Ideally, preparing a POLST should spark serious discussion about goals of care between terminally ill patients, their loved ones and medical providers.

“You want more, you get more. You want less, you get less,” Tolle added.

In Oregon, more than 250,000 POLST forms have been submitted to the registry since its inception in 2009, according to data compiled by Oregon POLST. More than 5,000 health care professionals have called the registry seeking forms.

A 2014 study co-authored by Tolle and published in the Journal of the American Geriatrics Society found that patients with POLST forms are highly likely to have their wishes honored.