The Role of POLST in Advance Care Planning End-of-Life Principles - PowerPoint PPT Presentation

The Role of POLST in Advance Care Planning

End-of-Life Principles End-Of-Life Care Is About: • Compassion at the bedside • Providing comfort • Honoring patients’ preferences

Advance Care Planning "Advance Care Planning Is Not An Event, It's A Process." * * Susan Tolle, director of the Center for Ethics in Health Care at Oregon Health & Science University 3

Gold Standard Discussing and following a patient’s preferences for end-of-life care should be as routine as asking about and responding to a patient’s allergies to medicines

Advance Care Planning Discussion Documentation Decision

Right to Refuse Medical Treatments • In Georgia, a competent adult has the right to refuse any unwanted medical treatment for any reason • Right to refuse medical treatments includes life support and other life-sustaining treatments • The right to refuse or terminate treatments may be exercised by family members or loved ones

Advance Care Planning Tools • Georgia Advance Directive for Health Care • Georgia Physician Order for Life Sustaining Treatments (POLST) • Wellstar “Tool Kit” / Education Packet

Georgia Advance Directive for Health Care One document for all health care preferences • Naming a health care agent / authorized person • Stating treatment preferences • Authorizing organ donation • Pt. Signature & 2 Witnesses

Georgia POLST • Medical order completed by a health care provider • Activates a patients Advance directive • Mechanism to communicate a patient’s wishes for their care at the end of their lives • Designed to travel with patient from one care setting to another

Who Should Have a POLST? • Anyone who might die within the next year • Anyone with an advanced chronic condition • Anyone choosing “Allow Natural Death”/DNR • Anyone residing in a long term care facility

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Georgia POLST Form • Developed by the Georgia Department of Public Health in 2012 pursuant to Official Code of Georgia Section 29-4-18(l) • Available at www.dph.ga.gov/POLST • Use and compliance with POLST form provides immunity to any “person” acting in good faith

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Georgia POLST Form Five Sections • Cardiopulmonary Resuscitation • Medical Interventions • Antibiotics • Artificially Administered Nutrition • Signatures

POLST Conversation • POLST is not just a check-box form • The POLST conversation provides context for patients/families to: ⁻ Make informed decisions ⁻ Identify goals of treatment • A patient or their Health Care Agent can request alternative treatment or revoke a POLST at any time

End-of-Life Documents Are Activated When, in the judgment of the physician, one of “three c onditions” are met: • Patient is in the last year of their life / a Terminal Condition • Patient is in a permanent state of unconsciousness • Medical judgment that CPR would be inappropriate

Healthcare Agent / Authorized Person Responsibilities: • To follow the p atient’s known preferences • To honor the patient’s Advance Directive and POLST • To act in the best interest of the patient 17

Healthcare Team Responsibilities: • To follow the patient’s known preferences • To honor the patient’s Advance Directive and POLST without regard to personal views • If unable to honor preferences, facilitate the transfer of patient’s care

“Getting it Right” • Honor all patients wishes • Encourage all patients to have an Advance Care Plan • Utilize POLST when patient condition applies • Apply reasonable medical judgment

Georgia POLST Collaborative • 30+ Statewide Organizations • Part of a national movement to promote POLST • Endorsed by the National POLST Paradigm Taskforce • Vision: All Georgians will have their health care preferences known and honored

Georgia POLST Collaborative • Mission: To improve healthcare at the end-of-life through 1) Promoting the utilization of the POLST form by health care professionals and institutions across the state and 2) Educating Georgians about advance care planning and the role of POLST in having their wishes honored.

“Conversation Project” an effort led by veteran Boston journalist Ellen Goodman and launched in August 2012 with backing from the Institute for Healthcare Improvement . Goodman says 60,000 people have visited www.theconversationproject.org, and 40% of them have downloaded a conversation-starter kit.

“Conversation Project” Goodman, who launched her project after a difficult experience caring for her own dying mother, says , "What we really need is to change the cultural norm from not talking about it to talking about it."

“Let’s Have Dinner and Talk About Death”  Michael Hebb  TED Talk  “Death Over Dinner.org  Three Question  What do we want our final days to look like?  Who do we want to be nears us?  How can we support the E-O-L wishes of those closest to us?

Keys • Choose a medical decision-maker • Decide what matters most in life • Flexibility for your decision-maker? • Tell others about your wishes • Ask doctors and lawyers the right questions

POLST Websites • Critical Conditions Planning Guide • www.critical-conditions.org • www.gapolst.org • www.dph.ga.gov/POLST • www.polst.org • www.capolst.org/documents/POLSTFAQ

Thank You