Communications during Life
Limiting Illness & POLST in SC
Walter Limehouse, MD, MA
MUSC Ethics Comte
Objectives
 Identify SC Coalition for Care of
Serious Illness (SCC-CSI)
 Outline MUSC clinical policy C-169
 Describe POLST in SC: POST
Serious Illness Communications
 SCMA & SCHA –revisit “medical futility” concern
(2010)

SCMA annual meeting resolution, May 2010:

STANDARD COMMUNICATION, CONSENT AND
DECISION-MAKING PROCESS FOR SERIOUSLY ILL
INPATIENTS IN SOUTH CAROLINA
Serious Illness Communications
 SCMA House of Delegates, May 2010





Determine decision-making capacity according
South Carolina law;
Determine decision makers or surrogates;
Determine patients’ understanding, beliefs,
values, and wishes;
Facilitate effective communication; and
Call palliative care and/or ethics consults to
address concerns.
SC Coalition for Care of Serious
Illness (SCC-CSI)
 Charter groups represent diverse state-
wide interests






SC Medical Association
SC Nurses Association
SC Hospital Association
SC Healthcare Ethics Network
Carolinas Center for Hospice & End-of-Life Care
SC Society of Chaplains, LifePoint, AARP
SCC-CSI Vision Statement
 SC delivers excellent communication and
shared decision-making for persons with
serious, chronic, or terminal illnesses
SCC-CSI Initiatives @ MUSC
 Improving communications

clinical policy C-169

Communication Process for Inpatients with
Life Limiting Illness
 POLST
Physician Orders of Life Sustaining Treatment

POST in SC
Physician Orders on Scope of Treatment
MUSC Clinical Policy C-169
 Communication Process for Inpatients
with Life Limiting Illness
Life-limiting illness triggers for
communications process
 Terminal illness with projected death
within 6 months
 Chronic debilitating illness with
readmissions and/or multiple ED visits
 Major events, like stroke, resulting in
direct ICU admission or transfer
 Other illnesses, as so determined by the
attending physician
Process Facilitator
 Nurse case manager or social worker as
shepherd



facilitates completion of process forms with
medical team
schedules meetings as needed to develop or
revise goals of treatment
may document meeting discussions and
attendance.
Process follows SCMA resolution





Determine decision-making capacity
Determine decision-makers or surrogates
Determine patients’ understanding, beliefs,
values, and wishes
Facilitate effective communication and
shared decision-making for time interval
Call palliative care and/or ethics consults
to address concerns
Forms
 Serious Illness Planning Progress Note

https://www.musc.edu/cce/ORDFRMS/pdf/all_all_docu_seriousillnesspl
anningprognote.pdf
 Serious Illness Continuing Care Planning
Progress Note
POLST paradigm
Physician Orders on Life Sustaining Treatment
 Physician orders

scope of resuscitative treatment during life
threatening emergency
 Advance planning with patients


patient death not unexpected within 1 year
Personal physician revises form with patient


upon change of patient condition or choices
annually
POLST paradigm
Physician Orders on Life Sustaining Treatment
 Orders cross institutional boundaries



home, assisted living, skilled nursing facility
EMS pre-hospital
Hospital

emergency department & inpatient
 POLST in Action in Oregon

(video)
http://www.youtube.com/watch?v=CtrrnAJfT2s&context=C3f17b7bADOEgsToPDskJZLOgVI-NCrNBJSeCyi--I
Oregon POLST
Form & Process
-1991
-Bright Pink
-Legally binding
for EMS
-Valid across
institutional
boundaries
SC EMS DNR
Form & Process
-Physician order
-Legally binding
for EMS
-Valid only
pre-hospital
National POLST Paradigm Programs
Endorsed Programs
Developing Programs
No Program (Contacts)
*As of February 2012
POLST: POST in SC
Physician Orders on Scope of Treatment
 SCC-CSI



organizational home for POST
SC POST form - near ready for adoption.
DHEC - ready to authorize POST pilots

Greenville & Charleston
 MUSC Medical Executive Committee

endorses CHARLESTON PILOT OF POST
 collaborative initiative with MUSC & Roper
POLST: POST in SC
Physician Orders on Scope of Treatment
 SCMA annual meeting, April 2012

resolution endorsing POST being introduced
Questions:
clinical policy C-169 or POST
 Please contact:


Walter Limehouse MD MA
limehouw@musc.edu