MOLST, Health Care Proxy
and Electronic Code
Status Order
Goals of Education/ Implementation

Instruct clinicians in use of standard tools to communicate patient
preferences across settings of care:
 Health Care Proxy
 MOLST (Medical Orders for Life Sustaining Treatment)
 Electronic Code Status Order
•
•
•
•
Code Status Displays in Header
Order detail visible in the Legal Indicators Tab
NEW Clinical Panel Code Status/Advance Directive
Order detail pulls into P.DOC discharge referral
Health Care Proxy



A basic ethical and legal right of every patient is to be able to make
decisions about their medical care. If a person is unable to
communicate, it is important that someone who knows their values
and preferences can make decisions for them.
If “invoked”, the Health Care Agent is expected to follow the
patient’s wishes and make decisions as the patient would make
them.
All adults, even healthy adults, are encouraged to choose a Health
Care Agent. Health care problems may arise suddenly; having a
surrogate decision maker provides an extra layer of security.
Invoking the Health Care Proxy (HCP)


When the Health Care Proxy form is invoked by
the provider, the agent becomes the legal
decision maker.
Provider must be sure he/ she is communicating
with the legal decision maker before making code
status decisions with that person.
What is MOLST?
Medical
Orders for
Life-Sustaining
Treatment
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MOLST is…

A medical document that may be used in the context of
advance care planning

Suitable for patients of any age with an advanced illness

Based on a patient’s current health status

Valid medical orders for life-sustaining treatments

A portable document that is valid across care settings
MA MOLST Demonstration Project: http://www.molst-ma.org/
Which patients are suitable for
MOLST?
Patients of any age with an advanced illness including, but
not limited to:
• Life-threatening diseases
• Chronic progressive diseases
• Life-threatening injuries
• Medical frailty
• Any patient suitable for considering DNR orders
MA MOLST Demonstration Project: http://www.molst-ma.org/
MOLST form side 1: Medical Orders
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MOLST form side 2: Patient Preferences
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Key Workflow Decisions:
Emergency Dept & Hospital


Paper process in ED. Electronic process in
inpatient setting.
Code status orders will be standardized in
Meditech 6.0 and a code status order will be
required for every inpatient upon admission
• Meditech 6.0 code status/ limitations in
care supersede the MOLST form in the
inpatient setting
ELECTRONIC CODE STATUS ORDER
IN MEDITECH
Use the type ahead search to find Code
Status order
Check Mark the Order > Next in the Footer
Complete the Required Fields
Advanced Directive Discussion and List by
Priority Order
Special Circumstances = If patient is not competent and has no
surrogate decision maker, refer to End of Life policy for DNR
ordering process.
Enter your PIN and Save Selected
Code Status on the Current Orders Screen
Detail on Legal Indicators Tab and Code
Status appears in the Header
NEW Code Status/Advance Directive
Clinical Panel
Detail in Clinical Panel View
Order Detail pulls into Discharge Referral
Complete Required Fields
Detail on Legal Indicators Tab and Code
Status appears in the Header
Detail on Advance Directive Clinical Panel
Order Detail pulled into Discharge Referral
Complete Required Fields
Detail on Legal Indicators Tab and Code
Status appears in the Header
Detail on Advance Directive Clinical Panel
Order Detail pulled into Discharge Referral