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Transcript of California POLST Education Program ©August 2014 Coalition for Compassionate Care of California...
California POLST Education Program©August 2014 Coalition for Compassionate Care of CaliforniaMaterials made possible by a grant from the California HealthCare Foundation
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POLST Community Presentation
PhysicianOrders for LifeSustainingTreatment
California POLST Education Program©August 2014 Coalition for Compassionate Care of CaliforniaMaterials made possible by a grant from the California HealthCare Foundation
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POLST
· What is POLST and why is it important?
· Overview of the POLST form
· How do I complete a POLST?
California POLST Education Program©August 2014 Coalition for Compassionate Care of CaliforniaMaterials made possible by a grant from the California HealthCare Foundation
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Why POLST?
· Patient wishes often are not known.– The Advance HealthCare Directive (AHCD)
may not be accessible.
– Wishes may not be clearly defined in AHCD.
– The AHCD is not a physician order.
· Allows healthcare professionals to know and honor your wishes for care.
California POLST Education Program©August 2014 Coalition for Compassionate Care of CaliforniaMaterials made possible by a grant from the California HealthCare Foundation
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POLST Conversations
· Focus is on the conversation.
· It is important to talk about and document your wishes before you become seriously ill.
California POLST Education Program©August 2014 Coalition for Compassionate Care of CaliforniaMaterials made possible by a grant from the California HealthCare Foundation
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Case Study: What We Know
California POLST Education Program©August 2014 Coalition for Compassionate Care of CaliforniaMaterials made possible by a grant from the California HealthCare Foundation
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Case Study: What We Didn’t Know
©California Medical Association 2000-2009
California POLST Education Program©August 2014 Coalition for Compassionate Care of CaliforniaMaterials made possible by a grant from the California HealthCare Foundation
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Case Study: What Happened
· AHCD not transferred with patient.
· DNR wishes not documented.
· Over-treatment against patient wishes.
· Unnecessary pain and suffering.
California POLST Education Program©August 2014 Coalition for Compassionate Care of CaliforniaMaterials made possible by a grant from the California HealthCare Foundation
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What is POLST?
· A physician order recognized throughout the medical system.
· Portable document that transfers with the patient.
· Brightly colored, standardized form for entire state of CA.
California POLST Education Program©August 2014 Coalition for Compassionate Care of CaliforniaMaterials made possible by a grant from the California HealthCare Foundation
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What is POLST?
· Allows individuals to choose medical treatments they want to receive, and identify those they do not want.
· Provides direction for healthcare providers during serious illness.
California POLST Education Program©August 2014 Coalition for Compassionate Care of CaliforniaMaterials made possible by a grant from the California HealthCare Foundation
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Who Would Benefit from Having a POLST Form?
· Chronic, progressive illness
· Serious health condition
· Medically frail
California POLST Education Program©August 2014 Coalition for Compassionate Care of CaliforniaMaterials made possible by a grant from the California HealthCare Foundation
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POLST History
· POLST development began in Oregon in 1991.
· Expanded to more than half of the United States.
· Studies have shown that POLST is effective in providing care that is consistent with patient wishes.
Developing Programs
National POLST Paradigm Programs
Endorsed Programs
No Program (Contacts)
*As of January 2014
Mature Programs
Regionally Endorsed Program
www.polst.org
Programs That Do Not Conform to POLST Requirements
California POLST Education Program©August 2014 Coalition for Compassionate Care of CaliforniaMaterials made possible by a grant from the California HealthCare Foundation
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POLST Success
Oregon Study: Location of Death and POLST Orders• 58,000 deaths reviewed, 31% had POLST in Oregon Registry
• Patient treatment choices honored, including avoiding dying in hospital
Fromme EK, JAGS 2014
Limited Interventions4,787
Hospital Death 22.4%
Out of Hospi-tal Death 77.6%
Comfort Measures Only11,836
Hospital Death 6.4%
Out of Hospital Death 93.6%
Full Treatment 1,153
Hospital Death 44.2%
Out of Hospi-tal Death 55.8%
California POLST Education Program©August 2014 Coalition for Compassionate Care of CaliforniaMaterials made possible by a grant from the California HealthCare Foundation
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POLST in California
· The Coalition for Compassionate Care of California (CCCC) is lead agency.
· Support from California HealthCare Foundation.
· Grassroots efforts of local POLST coalitions and communities.
California POLST Education Program©August 2014 Coalition for Compassionate Care of CaliforniaMaterials made possible by a grant from the California HealthCare Foundation
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POLST in California
Effective January 1, 2009
California POLST Education Program©August 2014 Coalition for Compassionate Care of CaliforniaMaterials made possible by a grant from the California HealthCare Foundation
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POLST in California
· One form for entire state.
· Use not mandated.
· Honoring form is mandated.
AB 3000, Wolk. Part 4, Sec 7, Probate Code Section 4782
California POLST Education Program©August 2014 Coalition for Compassionate Care of CaliforniaMaterials made possible by a grant from the California HealthCare Foundation
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POLST vs. Advance HealthCare Directive
· POLST complements the Advance HealthCare Directive (AHCD).
· POLST is not intended to replace the AHCD.· Both are legal documents.
AB 3000, Part 4, Sec 3, Probate Code 4780 (3) (c)
California POLST Education Program©August 2014 Coalition for Compassionate Care of CaliforniaMaterials made possible by a grant from the California HealthCare Foundation
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POLST vs. Advance HealthCare Directive
POLST AHCD· For seriously ill/frail,
at any age· Physician orders for
medical treatment· Can be signed by
decisionmaker
· For anyone 18 and older
· General instructions for treatment
· Appoints decisionmaker
California POLST Education Program©August 2014 Coalition for Compassionate Care of CaliforniaMaterials made possible by a grant from the California HealthCare Foundation
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Where Does POLST Fit In?
Advance Care Planning Continuum
Complete an Advance Directive
Complete a POLST Form
Age 18
Treatment Wishes Honored
Diagnosed with Serious or Chronic, Progressive Illness (at any age)
Update Advance Directive Periodically
C O N V E R S A T I O N
California POLST Education Program©August 2014 Coalition for Compassionate Care of CaliforniaMaterials made possible by a grant from the California HealthCare Foundation
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POLST vs. Pre-Hospital DNR(Do Not Resuscitate)
· Similarities:– Physician orders.– Address Do Not Resuscitate.– Intended for medically frail or those with
chronic or serious illness.
California POLST Education Program©August 2014 Coalition for Compassionate Care of CaliforniaMaterials made possible by a grant from the California HealthCare Foundation
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POLST vs. Pre-Hospital DNR(Do Not Resuscitate)
POLST Pre-Hospital DNR· Allows for choosing
resuscitation· Allows for other
medical treatments· Honored across all
healthcare settings
· Can only use if choosing DNR
· Only applies to resuscitation
· Only honored outside the hospital
California POLST Education Program©August 2014 Coalition for Compassionate Care of CaliforniaMaterials made possible by a grant from the California HealthCare Foundation
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How Do I Complete a POLST?
· Talk to your doctor about what kind of medical treatment you would want if you became seriously ill.
· Talk to your doctor about POLST.
· Talk to your family about your decisions.
California POLST Education Program©August 2014 Coalition for Compassionate Care of CaliforniaMaterials made possible by a grant from the California HealthCare Foundation
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Where Do I Keep a POLST?
Original pink POLST stays with you!
· At home:– Post in easy-to-find location (with AHCD).– Give to Emergency Medical Services.
· At Hospital or Skilled Nursing Home:– File in medical chart (with AHCD).– Goes with you if you are transferred.
California POLST Education Program©August 2014 Coalition for Compassionate Care of CaliforniaMaterials made possible by a grant from the California HealthCare Foundation
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Can POLST be Changed?
· You can change your POLST at any time.
· If you cannot speak for yourself, your healthcare decisionmaker may request a change based on a change in your condition or new information about your wishes.
California POLST Education Program©August 2014 Coalition for Compassionate Care of CaliforniaMaterials made possible by a grant from the California HealthCare Foundation
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POLST
· Talk with your doctor and your family
· Visit www.caPOLST.org