POLST Education for Healthcare Professionals Education for Healthcare Professionals ... • ANA Position Statement‐Nursing Care and DNR Decisions. ... POLST Education for Healthcare Professionals

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  • POLSTEducationforHealthcareProfessionalsHospiceandPalliativeNursesAssociation(HPNA)ELearning

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    POLST(PhysiciansOrdersforLifeSustainingTreatment)

    EducationforHealthcareProfessionals

    PresentedbyNancyJoyner,APRNCNS,ACHPN

    DisclosureNancyJoynerdoesnothaveanyfinancial,professionalorpersonalconflictofinterest

    Nancyspresentationwillnotrefertoproducts,drugsordevicesofacommercialcompanywithwhichIhaveasignificantrelationship

    Nancyhasnotacceptedafeefromacommercialcompanyforthispresentation

    Objectives1. IdentifywhatPOLSTisandwhoshouldhave

    POLST2. DiscussthekeyelementsofthePOLST3. DescribedifferencesbetweenHealthcare

    DirectivesandPOLST

  • POLSTEducationforHealthcareProfessionalsHospiceandPalliativeNursesAssociation(HPNA)ELearning

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    RealitiesLifeexpectancyincreased Increasedprevalenceofchronicdisease Increasedcomorbiditiesandfrailtyadvancingage

    Changingfamilies,healthcaresystems,societyandmarketplacedemands

    Deathbecomesoptional

    PhilosophyofPOLST Individualsright healthcaredecisionsDecisionsinclude:

    o Lifesustainingtreatmentoptionso Leveloflifesustainingtreatmento ComfortcareANDhavingwisheshonored

    WhatisthePOLSTParadigmMedicalorderProvidesconsistentinformation RecognizeddocumentAmechanismtocommunicatepatientpreferencesUsedacrosstreatmentsettings

  • POLSTEducationforHealthcareProfessionalsHospiceandPalliativeNursesAssociation(HPNA)ELearning

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    HealthcareDirectiveorPOLST?

    HealthcareDirective

    Foranyone18andolder Providesinstructionsfor future treatment

    Appointsahealthcarerepresentative

    Doesnotguideemergencymedicalpersonnel

    Guidesinpatienttreatmentdecisionswhenmadeavailable

    POLST

    Forseriouslyill/frail,atanyage

    Providesmedicalordersfor current treatment

    Guidesactionsbyemergencymedicalpersonnelwhenmadeavailable

    Guidesinpatienttreatmentdecisionswhenmadeavailable

    LimitationsofHealthcareDirectives/AdvanceDirectives(AD)NotavailableorknownNotcompletedbymostadultsNottransferredNotspecificenoughMaybeoverriddenbyaproviderDonottranslateintomedicalorderUsedonlywhenpatient/residentunableUsedonlyundercertaindelineations

    DevelopmentofPOLSTConsensusdevelopmentBeganin1991OngoingrevisionprocessVoluntaryprocessinOregonNationalPOLSTAdvisorypanel

  • POLSTEducationforHealthcareProfessionalsHospiceandPalliativeNursesAssociation(HPNA)ELearning

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    POLSTisSpreading(2007)11states

    OregonWashingtonGeorgiaKansasMissouriNewMexicoUtahWestVirginiaWisconsinNewYorkPennsylvania

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    *

    **

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    *

    *

    ****

    2009 34states

    11

    2011 AllBut9States

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  • POLSTEducationforHealthcareProfessionalsHospiceandPalliativeNursesAssociation(HPNA)ELearning

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    POLSTParadigmMission(whatissuccess)

    o TofacilitatePOLSTParadigmProgramsineverystateVision(whatdrivesus):

    o Toensurethatseriouslyillperson'swishesregardinglifesustainingtreatmentsareknown,communicated,andhonoredacrossallhealthcaresettings

    Objectives(whatwearedoing):1. Tofacilitatethedevelopment,implementationandevaluationofPOLSTParadigmProgramsintheU.S

    2. ToeducatethepublicandhealthcareprofessionalsregardingthePOLSTParadigm

    3. Tosupport,perform,andfundresearchrelatedtoendoflifecare

    4. Toimprovethequalityofendoflifecare5. http://www.ohsu.edu/polst/about/index.htm

    WhyhavePOLST? ImprovesthequalityofcareProvideseffectivecommunicationofpatientwishesDocumentsmedicalordersonaspecificformPromisetohonorthesewishesEnsuresdecisionsarepatientspecific

  • POLSTEducationforHealthcareProfessionalsHospiceandPalliativeNursesAssociation(HPNA)ELearning

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    ContinuityofPOLSTordersConsistentcolor identifiedAccuracyFlexibilityPortabilityAvailabilityLegalstandingemergencymedicaltechnicians

    PatientCenteredCare AdvancedCarePlanning

    Effectivecommunication Involvespatient(orlegallydesignateddecisionmaker)andhealthcareprofessionals

    EnsuresdecisionsaresoundBasedonthepatientsunderstandingof

    o theirmedicalconditiono theirprognosiso thebenefitsandburdensoftreatmento theirpersonalgoalsforcare

    Hope,Goals,ExpectationsHope,goals,expectationschangewithillnessPhysiciansroletoclarifygoals,treatmentplanTeammembersrole=supportpatientsgoalsSometakeprecedenceoverothersGradualshiftinfocusofcareExpectedpartofthecontinuumofmedicalcare HPNAPositionStatement TheNursesRoleinAdvanceCarePlanning ANAPositionStatement NursingCareandDNRDecisions

  • POLSTEducationforHealthcareProfessionalsHospiceandPalliativeNursesAssociation(HPNA)ELearning

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    ReviewingGoals,TreatmentPrioritiesGoalsguidecareAssessprioritiestodevelopinitialplanofcareReviewwithanychangein

    o Healthstatuso Advancingillnesso Settingofcareo Treatmentpreferences

  • POLSTEducationforHealthcareProfessionalsHospiceandPalliativeNursesAssociation(HPNA)ELearning

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    Spiritual&CulturalPerspectivesPOLSTsupportspatientautonomyPOLSTisconsistentwiththeCatholicmoraltraditionPOLSTisappropriatein:

    o Chronicorcriticalillnesso Advancedillness

    AboutnotsimplytoforgolifesustainingtreatmentAddressesinherentdignityofthepersonEssentialineverypersonalencounterExpresseddifferentlyineachencounter

    WhoShouldHaveAPOLST?PatientswithmultiplecomorbiditiesPatientswithserious,lifelimitingdiseasePatientswhomaynotsurviveanotheryearSomepatientsinICU,criticalcare,emergentsituations

    Others?

    BasisofPOLSTDiscussionwithpatientDiscussionwithsurrogatedecisionmakerPatientcentereddecision:

    o Patientsrequesto Patientsbestinteresto Patientsknownpreferenceo Medicalfutilityoftreatment(nonbeneficial)o CAREisneverfutile

  • POLSTEducationforHealthcareProfessionalsHospiceandPalliativeNursesAssociation(HPNA)ELearning

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    InitiatingPOLST Introduced/discussedwithpatientandfamilybyaphysician,nurse,socialworker,orchaplain

    Mustbesignedbyphysician,nursepractitioner,orphysiciansassistant

    Mustbesignedbypatientorproxy

    WherecanPOLSTbeinitiated?Long term

    care

    OfficePre-hospital& acute care

  • POLSTEducationforHealthcareProfessionalsHospiceandPalliativeNursesAssociation(HPNA)ELearning

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  • POLSTEducationforHealthcareProfessionalsHospiceandPalliativeNursesAssociation(HPNA)ELearning

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  • POLSTEducationforHealthcareProfessionalsHospiceandPalliativeNursesAssociation(HPNA)ELearning

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    BarrierstoPOLSTLegalIssues(Statestatutesandregulations)

    o Livingwillso Durablepowerofattorneyforhealthcareo Defaultsurrogateprovisionso Guardianshiplawo OutofhospitalDNRprotocolso Limitationsonconsenttoforgolifesustainingtreatment

  • POLSTEducationforHealthcareProfessionalsHospiceandPalliativeNursesAssociation(HPNA)ELearning

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    BarrierstoPOLSTEducationBuyinSettingsPolicy,rulesofinstitutions

    POLSTversusAdvanceDirectiveTrueorFalseAPOLSTformisonlyforadultpatientsAPOLSTformneedstobesignedbythephysicianandpatient/decisionmaker

    AnadvancedirectivecandirectmedicalpersonnelApersonswishesarealwaysknownwithaPOLST

    TrueorFalseAPOLSTformiskeptonthepatientsmedicalrecordinthephysiciansordersectionAnAdvanceDirectivegoesintoeffectwitheachhospitalizationWithaPOLSTthedecisionmakersigns,notthepatientAnAdvanceDirectiveshouldbedoneinalawyersofficeAPOLSTformgoesintoeffectwhenthepatientisunresponsive

  • POLSTEducationforHealthcareProfessionalsHospiceandPalliativeNursesAssociation(HPNA)ELearning

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    POLST:ANationalInitiativeRecognized/EndorsedbyNationalAgenciesCentertoAdvancePalliativeCare(CAPC)EndofLife/PalliativeEducationResourceCenter(EPERC)

    InstituteforClinicalSystemsImprovement(ICSI) InstituteofMedicine(IOM)NationalHospiceandPalliativeCareOrganization(NHPCO)

    POLSTNationalWebsitePOLST.ORG PhysiciansOrdersforLifeSustainingTreatmentParadigm

    Google:POLST

    POLSTSummaryEducate,encourage,communicateandadvocate

    AdvancecareplanningdiscussionPatientswishesDocumentation

    o Healthcaredirectiveo POLST

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