The Indiana POST Program:
An Overview
The POST Program
• POST = Physician Orders for Scope of
Treatment
– Converts treatment preferences into immediately
actionable medical orders
– Preferences to have or decline treatments
– Transfers across treatment settings with patient
– Recognizable, standardized form
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POST Paradigm Programs
Dark pink = endorsed
Light pink = developing
White = no activity
Source: www.polst.org
Research on POST
• POST supports patient-centered care by expanding beyond
DNR/full code orders (Hammes et al., 2012; Hickman et al.,
2004; 2009)
• POST is more effective than traditional approaches at
ensuring treatment preferences are documented as orders
(Hickman et al., 2010);
• POST orders do change the kinds of treatments patients
receive (Hickman et al., 2010);
• Treatments provided are largely consistent with POST
orders (Hickman et al., 2011);
• POST is viewed as helpful by clinicians including EMTs and
hospice personnel (Schmidt et al., 2004; Hickman et al.,
2009)
The Indiana POST Program
• Indiana Patient Preferences Coalition
– Mission: To develop a standardized tool to record
patient wishes as medical orders that transfer
across treatment settings with a goal of honoring
individual preferences for care.
• Membership of 60+ representing key
stakeholder groups
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Legislative History
• 2012 Session - HB 1114
– Did not make it out of committee
• 2013 Session - HB 1182
– Passed Indiana House 99-0
– Passed Indiana Senate 48-1 with amendments
– Concurrence passed 95-0
– Signed into law (IC
Who can have a POST?
• Must have one (or more) of the following
conditions:
– An advanced chronic progressive illness
– An advanced chronic progressive frailty
• Note: Frailty is a medical diagnosis
– A terminal condition
– Unlikely to benefit from CPR
• Would the patient’s physician be surprised if
the patient died within the next 12 months?
Who can fill out a POST form with a
patient?
– Physician or his/her designee (TBD by physician)
– Requires physician signature to execute the order
– Physician must provide license number, address,
and phone number
– Form must be signed by the patient or their legally
authorized representative
What if the patient lacks decisional
capacity?
• A POST form can be filled out based on a
conversation with:
– An appointed health care representative;
– An individual's attorney in fact with authority to
consent to or refuse health care for the individual;
– A legally appointed guardian (includes parents of
minor)
• Decisions must be based on prior known wishes
or best interest of patient
How does the POST work in the
hospital setting?
– POST is valid in ALL settings
– Should follow in emergency department setting unless
orders appear invalid or alternative treatment is
requested by patient/representative
– Admission orders should be consistent with POST
orders
– POST orders should be used to guide treatment
decisions including level of aggressiveness of
intervention in hospital
– Individual hospitals should develop policies and
procedures re POST