Transcript POST FORM - Tennessee End of Life Partnership

POST FORM
How does this affect me?
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Tennessee’s Health Care Decision
Act
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In 2004, the Health Care Decision Act was
passed thus revising Tennessee law
concerning health care decision making.
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What does this act do?
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Protects patient’s right to make own
health care decisions
Promotes Advance Directives
Reduces court involvement
Defines legal protection for those who
uphold
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Types of Advance Directives
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Durable Power of Attorney for Health
Care/Appointment of Health Care Agent
Living Will/Advance Care Plan
POST form/ Universal DNR
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How POST form came about?
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Tennessee needed one form to address
DNR and other resuscitative services
Tennessee needed one form utilized by all
healthcare entities in the state i.e. EMS,
Nursing Homes, Hospitals, etc.
Tennessee needed a universal form which
could travel and be recognized across
state lines
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Purpose of POST
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To provide a mechanism to communicate
patients’ preferences for end-of-life
treatment across treatment settings
To improve implementation of advance
care planning
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Basis of POST
Encourages discussion with patient and
family or surrogate decision maker of key
end-of-life care issues
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Impact of Tennessee Law
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Acknowledged “Universal Do Not Resuscitate Order”
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Means a written order that applies regardless of the treatment
setting and that is signed by the patient’s physician which states
that in event the patient suffers cardiac or respiratory arrest,
cardiopulmonary resuscitation should not be attempted.
The law also indicated the Board for Licensing Health Care
Facilities shall promulgate rules and create forms regarding
procedures for the withholding of resuscitative services from
patients
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lead to creation and development of POST form which was
approved as a MANDATORY FORM on February , 2006 by the
Board for Licensing Health Care Facilities
T.C.A. 68-11-224 (e), (5) & (i), (1)
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What is POST?
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POST – Physician Orders for Scope of Treatment
What purpose POST form serves
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Standardized form containing orders by a physician who has
personally examined a patient regarding that patient’s
preferences for end of life care
Complements, but does not replace Appointment of Health
Care Agent &/or Living Will/Advance Care Plan
Effective immediately upon order written and when all
requirements met
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Requirements for valid POST:
 Patient’s name and signature (Patient signature optional
according to facility policy)
 Orders
 Physician’s signature (MD/DO)
 Basis for orders
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POST Form Description
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POST Form format
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Top of Form
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Explanation of form
Any section of form not completed indicates full
treatment for that section
When need occurs, first follow orders, then contact
physician
Patient’s Name/DOB
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POST Description cont.
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POST Format cont.
CPR: Code or No Code?
 Level of intervention (i.e. comfort care only,
intermediate care, or full tx)
 Comfort care level stipulates: “Not to be
hospitalized unless comfort interventions in the
present setting fail” – as applicable to the facility
patient/resident is located in
 Use or withholding of antibiotics and feeding tubes
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POST Description cont.
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POST Format cont.
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Check 1 box each section
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SECTION A: Code Status
 Resuscitate or …
 Do Not Attempt Resuscitate
If neither is marked, patient is to be
resuscitated
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POST Description cont.
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POST Format cont.
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Section B:
Medical Interventions
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Comfort Interventions: Treat with dignity and respect.
Keep clean, warm, dry. Use medication by any route,
positioning, wound care & other measures to relieve
pain/suffering. Use oxygen, suction, manual tx of airway
obstruction as needed for comfort. Do not transfer to
hospital for life sustaining tx. Transfer only if comfort
needs cannot be met in current location.
Limited additional Interventions: Includes care described
above. Use medical tx, IV fluids and cardiac monitoring as
indicated. Do not use intubation, advanced airway
interventions, or mechanical ventilation. Transfer to
hospital if indicated. Avoid intensive care.
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POST Description cont.
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POST Format cont.
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Full TX/Resuscitation: All above plus CPR,
intubation, defibrillation
Other instructions_______________
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POST Description cont.
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POST Format cont.
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Section C: Antibiotics
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Treatment for new medical conditions
No antibiotics
Antibiotics
Other instructions____________
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POST Description cont.
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POST Format cont.
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Section D: Medically Administered Fluids &
Nutrition
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No IV fluids
IV fluids for a defined trial period
IV fluids long term
No feeding tube
Feeding tube for a defined trial period
Feeding tube long term
Other instructions__________
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POST Description cont.
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POST Format cont.
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Where does the Physician Sign?
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Section E:
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By a physician who has examined the patient (Mandatory)
Discussed with….
Physician’s printed Name/Phone #
Basis for Orders
Patient’s preferences
Patient’s best interest (Patient lacks capacity or preferences
unknown)
Medical indications
Other (specify)
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POST Description cont.
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POST Format cont.
Back of Form:
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Required Signatures:
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Patient/legal rep, surrogate (Patient’s signature is optional
according to facility policy)
Person preparing form
Title/phone number/date
Directions for Health Care Professionals:
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Completing POST
Using POST
Reviewing POST
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Who Can Fill Out POST Form?
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Physician
Social Worker – experienced in a health care
setting
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Nurse
*
MD signs regardless who completes and
must discuss form and contents with
patient/responsible party
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Need POST if has DNR Order?
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POST addresses more than just DNR Addresses…
Comfort level
IVs/Nutrition
Antibiotics
Documents what individual was involved in
discussion
Signature of pt, parent, or guardian or Health
Care Agent
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POST if for…
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Seriously ill patients*
Terminally ill patients
* chronic, progressive disease/s
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Is POST required on all patients?
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NO
Voluntary
Specifically focuses on medical treatment
patient does or does not want at end of
life
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What if Patient already has
Advance Directive?
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POST reinforces wishes expressed in
advance directive
POST is a physician’s order that should be
immediately used to direct the care of the
patient
Recommend very ill patients have both,
POST & Advance Directive
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Need DNR order if have POST?
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POST serves as the DNR order
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When Should Form be Reviewed?
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When patient is transferred from one health care facility to another
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Facility initiating transfer must communicate the existence of POST
form to receiving facility PRIOR to transfer (POST form must
accompany the patient to the receiving facility)
POST orders remain in effect in receiving facility
After admission, attending MD should review & a healthcare
professional should initial POST
If patient’s condition significantly changes, such as:
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Close to death
Extraordinary suffering
Improved condition
Advanced progressive illness
Permanent unconsciousness
When patient’s preferences change
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Changing the POST Form
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Void the form; complete a new one
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How to Void the POST
Draw a line through the Physician Orders
 Write the word “VOID” in large letters, then
 Sign or initial the form
 After voiding the form, a new form may be
completed – leave VOIDED form in permanent
record
 If no new form is completed, full treatment &
resuscitation may be provided
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Must Health Care Comply with
POST Form?
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YES
Providers can be disciplined by their
licensing board for failure to honor
advance directives or decisions of
surrogate, provided provider had actual
knowledge of directive
Law protects good faith compliance with
honoring Advance Directives
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Why POST Works
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By law MUST accompany patient
Contains specifics
It IS a physician’s order – no interpretation is
needed and POST orders are to be followed
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Take-Home Messages (about POST
Form)
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POST provides a better means to identify and
respect patient’s wishes
POST completions will improve end-of-life care
throughout the system
Use of POST will require communication to make
it work in your community
“Where’s the POST form?”
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www.tennessee.gov/health
www.endoflifecaretn.org
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