The Patient`s got a POLST…now what?
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Transcript The Patient`s got a POLST…now what?
Treating the person with a POLST in crisis
Purpose of POLST
To provide a mechanism to
communicate patient preferences for
end-of-life treatment across
treatment settings
Patient
Primary Care
Provider
Care facility
Emergency
Medical
Services
Hospital
Clinic/Specialist
POLST Basics
What do you look for first?
Patient name
MD/DO/PA or NP signature
○ Is there a T/O or V/O (verbal orders) signed by
an RN? --these are ok!
Date signed
If the above criteria are not met, the
form is not a valid medical order
Onto the orders
Section A: Cardiopulmonary Resuscitation
When does section A apply?
○ ONLY when the patient is NOT breathing AND
is pulseless.
Section A POLST-isms
“Until they die, it doesn’t apply”
“Once they’re dead, go ahead”
Section B: Medical Interventions
When does section B apply?
When the patient still has a PULSE and/or is still BREATHING
Section B POLST-isms
“Heart’s got a beat? See Section B for how to treat!”
“Is the patient still breathing? Then interventions they’ll be receiving”
Section B: Comfort Measures Only
Do: any intervention that will help keep the
patient comfortable
Do: Try to resolve care concerns that are
manageable by the providers on scene
If the issue becomes larger, consider calling
OLMC
Consider transporting only when the
patient cannot be kept comfortable at their
primary location
Does
not mean do not treat!
Section B: Limited Additional
Interventions
Do simple, minimally invasive
interventions
Avoid intubation
Do: Transport if there is a simple
medical intervention that can be
provided by the ED or hospital
Section B: Full Treatment
Treat
as per your
standard of care for that
particular condition!
Scenario 1:
EMS arrives at the home of a 78yom c/o
SOB, GCS 15. Pt’s son is on scene and
presents you with a POLST that is signed
by the physician but bears no patient
signature. PMH: COPD, HTN
Can you follow the orders?
Form states DNR, Limited Additional
Interventions
Which order is most relevant in the
patients’ current medical state?
What treatments would you consider?
Scenario 2: POLST & the CA pt
Arrive on scene of a 52 year old woman,
thin and ill- appearing with metastatic
breast cancer. She is c/o new onset
nausea and pain in her jaw.
What else do you need to know?
Before seeing a POLST form what
treatments are you considering?
Scenario 2: 12-lead results
Kern, Morton MD “The Different Presentations of Acute STEMI: What Problems Should the
Cath Lab Look For?” 12/30/10; www.cathlabdigest.com
Now what?
Do you transport?
Would your decision to transport change if
you were able to control the patient’s pain on
scene?
If you decide to transport where do you
transport to?
What info should you relay to the receiving
hospital besides that this is a STEMI
patient?
Quiz time!
Can you follow POLST orders that are
from a different state than Oregon?
Yes! (Question… contact OLMC)
Are copies of POLST form ok??
Yes!
Scenario #3
72yom, general malaise who stated “I just
don’t feel right.”
What is the first thing you need to find out?
The patient is awake and c/o CP & SOB.
Monitor shows V-tach
Treatments?
You decide you’d like to cardiovert
What do you explain to the patient?
Cardiovert asystole
Now what?
Quiz time!
When do you consider using CPAP on
the patient with a POLST order of CMO?
The patient has to be alert enough to
cooperate in order to try CPAP.
Is it helping?
○ Yes—then this is a comfort measure
○ No—then take it off, and try something else
Scenario 4: I’ve fallen and I can’t get
up!
88 year old woman falls at care facility.
GCS13. BP 94/70, P 96; unstable pelvis.
RN on scene hands you POLST form:
DNR, CMO
Does the POLST form influence your
decision to transport?
Does it change the destination?
It’s easy!
When should I call?
Elderly, frail patients
Terminally ill patients
Chronic, progressive illness patients
If someone states there may be a POLST but cannot
provide a copy
If you are not certain the POLST for you have is
current
What is the Oregon POLST Registry?
Secure electronic database of
POLST forms.
Owned by the state of
Oregon, operated by the
Emergency Communication
Center at OHSU and available
statewide.
Emergency medical
professionals treating a
patient can access POLST
orders if the original POLST
form cannot be immediately
located.
How do I access the POLST Registry?
For emergent needs
•
–
Call the POLST Registry EMS
Hotline*
State: “This is <your name & title>
from<Agency name>, with a POLST
form request”
Provide some of the following patient identifiers, as requested
by the Registry Hotline staff:
•Full name
•Date of Birth
•Gender
•Last 4 SSN
•POLST Registry ID #
•Home address/residential
care facility address
•City, County, or zip code
*this number is available for EMS, ED and acute care hospital unit use ONLY.
It is not for public distribution or dissemination
Do I need to have all those identifiers?
NO!
If possible, start with these identifiers
Registry ID
○ This may be present in a person’s personal effects on a
bright pink sticker (example right)
Date of Birth
First and last name
Hotline
staff may request additional
identifiers to confirm the identity of a patient
What information will be provided?
•
The Registry staff can verbally relay:
• Section A and B orders
• Date the form was signed
• Patient’s POLST Registry ID
•
THE STAFF ARE NOT MEDICAL
PROVIDERS, AND CANNOT
INTERPRET POLST ORDERS
• If you need guidance, contact On-Line
Medical Control
Transporting?
Let us know! We will
fax a copy of the
POLST to your
destination hospital
What do I document?
Verbal orders relayed
Example: DNR; Limited additional interventions
Date the form was signed
POLST Registry ID
You can always call the business office and request a copy
of the POLST for your chart. Calls received after hours
will be faxed the next business day
The Oregon POLST Registry Office
EMS Contact Jenny Cook, Oregon POLST Registry
Liaison
Call for any non-urgent questions, or educational
information or onsite training requests.
Phone: 503-494-1230
Toll free: 877-367-7657
Fax: 503-418-2161
E-mail: [email protected]
Website: www.orpolstregistry.org