JFK MEDICAL CENTER
DEPARTMENT/OWNER:
Risk Management
POLICY DESCRIPTION:
Physicians Orders for Life Sustaining Treatment (POLST)
Page 1 of 4
REPLACES POLICY DATED:
EFFECTIVE DATE: 4/11
REFERENCE NUMBER:
COMMITTEE APPROVAL:
APPROVAL DATE:
ADMINISTRATIVE APPROVAL:
APPROVAL DATE:
SCOPE:
All Medical and Hospital Staff involved in care of patient.
PURPOSE:
To provide guidelines to assure that decisions regarding withholding of resuscitative services or lifeprolonging treatments and procedures for patients are made in the framework of a medically responsible,
ethical and sensitive process that protects the right of the patients and adheres to the Florida Statutes The
POLST order set will serve as a guide for discussions regarding the use/nonuse of specific resuscitative
measures.
.
The POLST order set will serve as a guide to improve end-of-life care by converting patients' preferences
for life-sustaining treatments into immediately actionable medical orders that are transferable throughout
the health care system.
POLICY:
1.
In accordance with Florida Law, JFK Medical Center agrees, that every competent adult has the
fundamental right to self-determination regarding decisions pertaining to his/her own health,
including the right to choose to refuse medical treatment.
The Hospital will respect and abide by a patient's wishes for end-of-life life decisions to the extent
permitted by Florida State Statute and the federal law regarding "Self Determination".
2.
The POLST Form is completed based on conversations among health care professionals with the
patient and/or the appropriate proxy decision makers, in conjunction with any existing advance
directive for incapacitated patients.
DEFINITIONS (765.101)
"Physician Orders for Life Sustaining Treatment (POLST)" is an order set that aims to honor a patient's end of life
care wishes as stated in their oral or written living will.
"Do Not Resuscitate Order" means a written medical order prepared by the attending physician that documents
instruction by an adult patient, the patient's designated Surrogate, or an appointed Proxy, that in the event the
patient suffers cardiac or respiratory arrest; cardio-pulmonary resuscitation is to be withheld.
"Life Prolonging Procedures" means any medical procedure, treatment or intervention, including artificially
provided sustenance and hydration, which sustains, restores, or supplants a spontaneous vital function. The term
does not include the administration of medication or performance of medical procedures, when such medication or
procedure is deemed necessary to provide comfort care or to alleviate pain.
"Advance Directive" means a witnessed written document or an oral statement in which instructions are given by a
principal or in which the principal's desires are expressed concerning any aspect of the principal's health care,
and includes, but is not limited to, the designation of a health care surrogate, a living will or an anatomical gift
made pursuant to Part X of Chapter 732.
JFK MEDICAL CENTER
DEPARTMENT/OWNER:
Risk Management
POLICY DESCRIPTION:
Physicians Orders for Life Sustaining Treatment (POLST)
Page 2 of 4
REPLACES POLICY DATED:
EFFECTIVE DATE: 4/11
REFERENCE NUMBER:
COMMITTEE APPROVAL:
APPROVAL DATE:
ADMINISTRATIVE APPROVAL:
APPROVAL DATE:
"Living Will or Declaration" means:
1.
A witnessed document in writing, voluntarily executed by the principal in accordance with s.
765.302; or
2.
A witnessed oral statement made by the principal expressing the principal's instructions concerning
life-prolonging procedure
"Health Care Surrogate" means any competent adult expressly designated by a principal to make health care
decision on behalf of the principal upon the principal's incapacity.
"Durable Power of Attorney for Health Care” is an appointed agent, or a so called "attorney-in-fact", to act for
individual in execution of legal, business, property affairs and making of health care decisions in place of
establishing a legal guardian.
"Proxy" means a competent adult who has not been expressly designated to make health care decisions for a
particular incapacitated individual, but who, nevertheless, is authorized pursuant to s. 765.401 to make health care
decisions for such individual.
"Close Personal Friend" means any person 18 years of age or older who has exhibited special care and concern for
the patient, and who presents an affidavit to the health care facility or to the attending or treating physician stating
that he or she is a friend of the patient; is willing and able to become involved in the patient's health care; and has
maintained such regular contact with the patient so as to be familiar with the patient's
activities, health, and religious or moral beliefs.
"Incapacity or Incompetent" means the patient is physically or mentally unable to communicate a willful and
knowing health care decision. For the purpose of making an anatomical gift, the term also includes a patient who is
deceased.
PROCEDURE:
1.
2.
3.
4.
5.
The attending physician will make every effort during the patient's hospitalization to transform a
patient's wishes outlined in their living will into an actionable POLST order set if one has not
already been completed.
If a patient comes to the hospital with a valid POLST order form in their possession, the attending
physician should ensure that the orders are reviewed with the patient (or his/her proxy) and that the
"Review of this POLST form" section of the POLST order form is signed and dated. All orders
listed on the out of hospital POLST order set must be followed as if they were written by a
physician with medical privileges at JFK Medical Center.
If a person does not have a valid POLST form, and the patient has decision making capacity, then
the physician should discuss the issue of completing a POLST order form with the patient.
The POLST Form is designed to transfer across treatment settings, so it is readily available to
medical personnel, including emergency medical technicians (EMTs), emergency physicians, and
nursing facility staff.
Completion of the POLST form must be done by a health care professional based on medical
indications, a discussion of treatment benefits and burdens, and elicitation of patient preferences.
JFK MEDICAL CENTER
DEPARTMENT/OWNER:
Risk Management
POLICY DESCRIPTION:
Physicians Orders for Life Sustaining Treatment (POLST)
Page 3 of 4
REPLACES POLICY DATED:
EFFECTIVE DATE: 4/11
REFERENCE NUMBER:
COMMITTEE APPROVAL:
APPROVAL DATE:
ADMINISTRATIVE APPROVAL:
APPROVAL DATE:
6.
7.
8.
9.
10.
11.
12.
13.
The POLST form must be signed by a physician and the patient/resident or health care
surrogate/proxy to be valid.
A person with capacity or the surrogate/proxy (if patient lacks capacity) can revoke the POLST at
any time and request alternative Treatment.
Use of original form is strongly encouraged; however photocopies and Faxes of signed POLST
forms are legal and valid.
Any section of the POLST form not completed implies full treatment for that section.
A semi-automatic external defibrillator (AED) should not be used on a person who has chosen "Do
Not Attempt Resuscitation."
When comfort cannot be achieved in the current setting, the person, including someone with
"comfort measures only" should be transferred to a setting able to provide comfort, such as a
hospice unit. An IV medication to enhance comfort may be appropriate for a person who has
chosen "Comfort Measures Only".
Oral fluids and nutrition must always be offered if medically feasible.
Treatment of dehydration is a measure which may prolong life. A person who desires IV fluids
should indicate "Limited Interventions" or "Full Treatment."
The paper copy of the POLST form will be placed in the Advance Directive section of the paper
chart while the patient is hospitalized. Upon discharge from the facility, the original will be sent
along with the patient while a copy of the POLST order set will remain in the
medical record.
14.
POLST should be reviewed periodically and a new POLST completed if necessary When
a.
The person is transferred from one care setting or care level to another, or
b.
There is a substantial change in the person's health status, or
c.
The person's treatment preferences change
15.
To void the POLST Form, draw a line through the sections A through F and write "VOID" in large
letters.
16.
Living Wills or oral declaration, other advance directives and POLST Order Sets (including those
completed by a physician not on staff at JFK Medical Center) will be honored according to Florida
Law and will be included as a part of the patient's medical record. This applies to both inpatient as
well as outpatients.
17.
All Physicians who complete a POLST order set will be educated on the patient rights during
orientation and will be encouraged to complete a one hour on-line CME to learn how to conduct a
conversation regarding advance care planning.
18.
All staff members participating in the request of Advance Directives will be educated on patient
rights during orientation and reorientation. Risk Management may be contacted for any question.
SPECIAL CIRCUMSTANCES
A.
END OF LIFE CARE
1.
All patients with POLST orders shall be treated with the same dignity and respect as is required for
all patients.
2.
Please see Policy and Procedure for "Do Not Resuscitate" for specific issues regarding end of life
care.
B. CONFLICT RESOLUTION
JFK MEDICAL CENTER
DEPARTMENT/OWNER:
Risk Management
POLICY DESCRIPTION:
Physicians Orders for Life Sustaining Treatment (POLST)
Page 4 of 4
REPLACES POLICY DATED:
EFFECTIVE DATE: 4/11
REFERENCE NUMBER:
COMMITTEE APPROVAL:
APPROVAL DATE:
ADMINISTRATIVE APPROVAL:
APPROVAL DATE:
1.
Decisions concerning removing or withholding life support and/or resuscitative services (including
CPR) from an individual are made by the patient in consultation with the Physician, Designated
Surrogate or Appointed Proxy and Family Members. Nursing and Risk Management assistance
may be requested when needed.
2.
If conflicts in this decision-making process occur, the patient's wishes, if known, take precedent.
3.
If the patient is not competent to state their decision regarding health care, conflicts will be settled
with the designated surrogate or appointed proxy in the patient's absence.
4.
The patient's family, the Hospital, the Attending Physician or any other interested person who may
reasonably be expected to be directly affected by the decision may seek expedited judicial
intervention, if that person believes:
a.
The Surrogate's or Proxy's decision is not in accord with the patient's knowledge, desires or
the provisions of the law.
b.
The advance directive is ambiguous, or the patient has changed his/her mind after
execution of the Advance Directive.
c.
The Surrogate or Proxy was improperly designated or appointed
or the designation of the
Surrogate is no longer effective.
5.
Conflicts between Physicians and Families, Patient, or Surrogate should be referred Risk
Management or Administration. If a solution cannot be reached, any continuing conflicts may be
referred to the Clinical Ethics Committee.
Developed:
Reviewed:
Revised:
Owner:
4/11
Director Risk Management