POLST Physician Orders for Life-Sustaining Treatment Training Contra Costa EMS Agency Policy 20...
-
Upload
samantha-fleming -
Category
Documents
-
view
212 -
download
0
Transcript of POLST Physician Orders for Life-Sustaining Treatment Training Contra Costa EMS Agency Policy 20...
![Page 1: POLST Physician Orders for Life-Sustaining Treatment Training Contra Costa EMS Agency Policy 20 Change Effective 1/1/2009.](https://reader035.fdocuments.in/reader035/viewer/2022072014/56649e865503460f94b898f7/html5/thumbnails/1.jpg)
POLSTPhysician Orders for
Life-Sustaining TreatmentTraining
Contra Costa EMS AgencyPolicy 20
Change Effective 1/1/2009
![Page 2: POLST Physician Orders for Life-Sustaining Treatment Training Contra Costa EMS Agency Policy 20 Change Effective 1/1/2009.](https://reader035.fdocuments.in/reader035/viewer/2022072014/56649e865503460f94b898f7/html5/thumbnails/2.jpg)
POLSTPhysician Orders for Life-
Sustaining Treatment Training Objectives
• Define POLST and how the POLST form will be used in the prehospital setting in CCC.
• Determine what treatment to perform when Section A or B of the POLST form are marked.
• Identify that Section C is not applicable to the prehospital setting.
• Identify when a POLST form is valid.
![Page 3: POLST Physician Orders for Life-Sustaining Treatment Training Contra Costa EMS Agency Policy 20 Change Effective 1/1/2009.](https://reader035.fdocuments.in/reader035/viewer/2022072014/56649e865503460f94b898f7/html5/thumbnails/3.jpg)
What is POLST?• A form mandated by passage of
California Assembly Bill 3000 this past year
• Intended to aid in communication of patient’s treatment wishes (in form of a physician order)
• An alternative to the DNR order form with more complex treatment options for patients who are not in cardiac arrest
![Page 4: POLST Physician Orders for Life-Sustaining Treatment Training Contra Costa EMS Agency Policy 20 Change Effective 1/1/2009.](https://reader035.fdocuments.in/reader035/viewer/2022072014/56649e865503460f94b898f7/html5/thumbnails/4.jpg)
What is POLST?
• Primarily intended as a communication tool between nursing homes, hospices and hospitals.
• The form is not ideal for EMS (we are in the middle). Our EMS policies will continue to dictate care and interpretation of the form when the patient is in our hands.
![Page 5: POLST Physician Orders for Life-Sustaining Treatment Training Contra Costa EMS Agency Policy 20 Change Effective 1/1/2009.](https://reader035.fdocuments.in/reader035/viewer/2022072014/56649e865503460f94b898f7/html5/thumbnails/5.jpg)
In a Nutshell….• Front side of form has parts A through D.
– A and B are applicable to EMS– C is only applicable to facilities– D is signature section
• Back side has instructions for use. However, EMS care is dictated by our policy, not by the statements on the back side of the form.
• Original is supposed to be printed on bright pink paper, but photocopies and faxes are acceptable.
![Page 6: POLST Physician Orders for Life-Sustaining Treatment Training Contra Costa EMS Agency Policy 20 Change Effective 1/1/2009.](https://reader035.fdocuments.in/reader035/viewer/2022072014/56649e865503460f94b898f7/html5/thumbnails/6.jpg)
If POLST Form is Presented….1. Make sure patient is identified correctly
at the top of the form
2. Check Section D for signatures - to be valid, form must have signature of physician and patient (or other decision-maker)
3. If patient has no pulse and is not breathing, follow section A (to either resuscitate or not) – just like DNR forms
![Page 7: POLST Physician Orders for Life-Sustaining Treatment Training Contra Costa EMS Agency Policy 20 Change Effective 1/1/2009.](https://reader035.fdocuments.in/reader035/viewer/2022072014/56649e865503460f94b898f7/html5/thumbnails/7.jpg)
Top of Form andSection A: Cardiopulmonary Resuscitation
Should be followed just like DNR Form
![Page 8: POLST Physician Orders for Life-Sustaining Treatment Training Contra Costa EMS Agency Policy 20 Change Effective 1/1/2009.](https://reader035.fdocuments.in/reader035/viewer/2022072014/56649e865503460f94b898f7/html5/thumbnails/8.jpg)
Section B – Medical Interventions:
EMS Transport
4. For use when patient has a pulse and/or is breathing:
– For EMS purposes, information concerning patient transfer should be disregarded (“do not transfer” advisories). This is not intended as a “treat and release” authorization.
– Follow EMS Policy 10 if patient or family declines treatment/transport.
![Page 9: POLST Physician Orders for Life-Sustaining Treatment Training Contra Costa EMS Agency Policy 20 Change Effective 1/1/2009.](https://reader035.fdocuments.in/reader035/viewer/2022072014/56649e865503460f94b898f7/html5/thumbnails/9.jpg)
Section B – Medical Interventions
EMS Care
5. The only checkboxes which change EMS care are the “Comfort Measures Only” or “Limited Additional Interventions” boxes (first and second boxes):
– Only one box in Section B is supposed to be checked, but if either of first two boxes are checked, do not intubate.
![Page 10: POLST Physician Orders for Life-Sustaining Treatment Training Contra Costa EMS Agency Policy 20 Change Effective 1/1/2009.](https://reader035.fdocuments.in/reader035/viewer/2022072014/56649e865503460f94b898f7/html5/thumbnails/10.jpg)
Section B
Follow EMS Policy 10 for transport issues (not this form).
Do not intubate if either of the top two boxes are checked.
![Page 11: POLST Physician Orders for Life-Sustaining Treatment Training Contra Costa EMS Agency Policy 20 Change Effective 1/1/2009.](https://reader035.fdocuments.in/reader035/viewer/2022072014/56649e865503460f94b898f7/html5/thumbnails/11.jpg)
![Page 12: POLST Physician Orders for Life-Sustaining Treatment Training Contra Costa EMS Agency Policy 20 Change Effective 1/1/2009.](https://reader035.fdocuments.in/reader035/viewer/2022072014/56649e865503460f94b898f7/html5/thumbnails/12.jpg)
If Full Treatment checked, proceed with usual EMS care. Contact base if any questions.
Transfer directives are for facilities only. Follow EMS policy 10 if patient or family declines treatment or transport.
![Page 13: POLST Physician Orders for Life-Sustaining Treatment Training Contra Costa EMS Agency Policy 20 Change Effective 1/1/2009.](https://reader035.fdocuments.in/reader035/viewer/2022072014/56649e865503460f94b898f7/html5/thumbnails/13.jpg)
Section B Issues
• Any questions about appropriateness of other treatment can be discussed with base hospital if needed.
![Page 14: POLST Physician Orders for Life-Sustaining Treatment Training Contra Costa EMS Agency Policy 20 Change Effective 1/1/2009.](https://reader035.fdocuments.in/reader035/viewer/2022072014/56649e865503460f94b898f7/html5/thumbnails/14.jpg)
Section C
Not for Prehospital Use
![Page 15: POLST Physician Orders for Life-Sustaining Treatment Training Contra Costa EMS Agency Policy 20 Change Effective 1/1/2009.](https://reader035.fdocuments.in/reader035/viewer/2022072014/56649e865503460f94b898f7/html5/thumbnails/15.jpg)
Other Issues• DNR forms are still valid. If patient has
both, utilize form with the latest date.• If section A incomplete, full treatment
should be done.• If section B incomplete (no box
checked), full treatment should be done• If section D signatures of physician and
patient are not complete, full treatment should be done.
• If a DNR or POLST form is presented, but relatives on scene object to the order or the validity of the form is in question, full treatment should be done.