Medical Orders for Life-Sustaining Treatment (MOLST) Program
A POLST Paradigm Program
A Community-Wide End-of-Life/Palliative Care Initiative Project
Definition and Needs Assessment
Definition
MOLST is designed to improve the quality of care people receive at the
end of life. MOLST is based on:
Effective communication of patient wishes
Documentation of medical orders on a brightly colored pink form
A promise by health care professionals to honor those wishes.
Needs Assessment
Traditional advance directives like the living will are insufficient
Require further interpretation
Do not result in medical orders
Are too often ignored
Regional variations in cost of care
Disparity between patient preferences and actual site of death
MOLST Program Dissemination
Systems Integration
Advance Care Planning
Advance Directives
Compassion, Support and Education along the Continuum
Integration into Care Management
NYS health care facilities
Community Pilot
Partnerships
Chronic disease or
functional decline
Disease Management
39 county service region
EPEC Faculty and attendees
Advancing chronic illness
Case Management
Trained ACP Facilitators
Traditional ADs
For All Adults
Multiple co-morbidities,
with increasing frailty
Complex Case
Management
Community Conversations on
Compassionate Care (CCCC)
New York State
-Health Care Proxy
New York State Department of Health
Medical Society of the State of New York
-Living Will
Maintain
and
maximize
health and
independence
Wellness and
Health Promotion
SEMAC/SEMSCO
Death with dignity
Hospice
Organ Donation
State-specific forms
2003—Created MOLST form, adapted from Oregon’s POLST
March 2004—Developed collaboration with NYSDOH
June 2005—Passed legislation for MOLST Community Pilot in
Monroe and Onondaga counties
October 2005—Revised MOLST form
Consistent with New York State Public Health Law
Approved for use in all health care facilities in New York State
2006—Chapter Amendment permits DNI in MOLST
Community Pilot counties
For those who are Seriously Ill
or Near the End of Their Lives
Medical Orders for Life-Sustaining Treatment
(MOLST) Program
Do Not Resuscitate (DNR) Order
Medical Orders for Life-Sustaining
Treatment (MOLST)
Physician Orders for Life-Sustaining
Treatment (POLST) Paradigm
Programs
CompassionandSupport.org
CaringInfo.org
Functional health illiteracy
2001—Initiated work on MOLST
Actionable Medical Orders
CompassionandSupport.org
POLST.org
MOLST 8-Step Protocol
MOLST Guidebook including FAQs
MOLST Patient & Family Brochure (English & Spanish)
Distribution and fulfillment
Sample Facility Policies & Procedures
Training
Sample Facility Implementation/Education Workplans
Quality Improvement
MOLST Training Manual
Monitor Performance
Share best practices and lessons learned
Funding
MOLST “Train-the-Trainer” Sessions and Conferences
MOLST DVD and web-based tools
MOLST EMS Training
Sustainability
MOLST Training Center:
Variation in models
MOLST DVD and Educational Resources
Other professional associations
History of the MOLST Program
Leadership
Operations
Healthy and
independent
Regional End-of-Life Coalitions
Role of Health Plan
MOLST Community Resources
Community website: www.CompassionandSupport.org
www.CompassionandSupport.org
Functional Health Literacy
CPR/DNR
Capacity Assessment
Stages of MOLST Development and Implementation Success Across New York State and as a POLST Paradigm Program
Tube Feeding Guidelines
Community-Wide End-of-Life/Palliative Care Initiative
Advance Care Planning
CCCC
Honoring Patient Preferences
MOLST
Pain Management and Palliative Care
Community Principles of Pain Management
Education and Communication
Education for Physicians on End-of-Life Care (EPEC)
Community website: www.CompassionandSupport.org
2005-2008—Successful MOLST Community Pilot
July 2008—Governor Paterson signs bill modifying PHL§2977(3)
Permits MOLST use in communities throughout New York State
Permanent change in EMS scope of practice
Performance Goals
Short-term Goals
Consistent uniform application of the MOLST program
Successful MOLST Community Pilot and adoption of MOLST as a statewide program
Volunteers prepared to engage in community conversations regarding end-of-life issues,
options and the value of advance directives, including the MOLST form
Long-term Goals
Informed and prudent use of life-sustaining technologies and intensive care services
Greater efficiencies in health care delivery
Improved patient and family satisfaction
Reduction in costs associated with medical liability and defensive medicine by providing
physicians an efficient framework for discussing end-of-life options
Interventions
Health Care Facilities
Standardized practices, policies, procedures and form
Community
Community Pilot Results
Education and training for professionals
MOLST is well-recognized
Timely discussions prompted by:
Trained professionals can read it and understand its intent
Identification of appropriate cohort
Prognosis
MOLST framed as an end-of-life care transitions program
No untoward consequences or major issues with MOLST
MOLST endorsed by SEMAC and SEMSCO
Community Education
Quality improvement process for form and system
Advance Care Planning Facilitators
Shared best practices
Consumer Education
Community website: www.CompassionandSupport.org
Lessons Learned
A health care and community collaborative model can effectively
improve end-of-life care
Next Steps
Health Plans can provide effective leadership for this model
EMS training
Model can be replicated using six steps:
Expansion of professional, facility, and community training
1. Define vision, mission and values
Further legislative work with OMH and OMRDD
2. Employ results-oriented approach
eMOLST Registry and community workflow
3. Design effective, inclusive coalition membership
Establish partnerships with other Blue Plans
4. Create effective leadership
Extend MOLST further in Care Management functions
5. Demonstrate strong commitment to purpose
6. Monitor performance