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New OkPOLST form designed to improve end-of-life and crisis care

published in McAfee & Taft Healthcare Alert | August 23, 2016

Beginning Friday, August 26, 2016, Oklahomans have another tool available to them for use in planning end-of-life care and treatment. It’s called an OkPOLST, which stands for Oklahoma Physician Orders for Life-Sustaining Treatment. An OkPOLST is a standardized form printed on pink paper and filled out by a patient and his/her physician together. The purpose of an OkPOLST is to document the patient’s preferences regarding the administration of crisis and end-of-life treatments such as CPR, intubation and mechanical ventilation, and comfort measures, and then incorporate those preferences into a physician order. The OkPOLST process is intended to encourage advance care planning and to translate the patient’s wishes for his/her own care into an order from the patient’s physician that will follow the patient regardless of residential or medical setting.

An OkPOLST is purely voluntary. It is not biased for or against any specific course of treatment. Many states have already adopted the use of a POLST.

An OkPOLST is not for a healthy adult contemplating, in the abstract, what may happen to them in the future. It is designed for someone of any age who is seriously ill with a life-limiting or terminal illness; who is frail and has trouble performing routine daily activities; who may lose the capacity to make his/her own healthcare decisions in the near future; or who is living in a nursing home or under hospice care. The OkPOLST reflects the level of life-sustaining care and treatment that the patient, in his/her current state of health, wants, and enables the patient, through a physician’s order, to direct treatment across care settings, including emergency medical personnel.

An OkPOLST is intended to complement an advance directive, commonly called a “living will.” A patient may have one or both. There are several main differences. One, an advance directive contains general instructions from anyone age 18 or older for future treatment in the event he/she becomes unable to speak for him/herself. It can only be executed by the patient. In contrast, an OkPOLST contains specific physician orders for treatment to be provided to a person already in compromised or frail health. It may be executed by a legal healthcare representative if the patient lacks capacity. An advance directive may be used to appoint a healthcare representative; an OkPOLST may not. An OkPOLST is effective immediately, while an advance directive does not become effective until the patient cannot speak for him/herself. An OkPOLST provides a medical order for emergency medical personnel, while an advance directive does not. Finally, while an advance directive may be difficult to locate during a crisis, an OkPOLST becomes part of the medical record and travels with the patient across healthcare settings.

Again, an OkPOLST is voluntary. It can be voided by the patient at any time. It should be reviewed at least annually and updated, if necessary, when the patient is transferred from one care setting or care level to another, when there is a substantial change in the patient’s health status, or when the patient’s treatment preferences change. In addition, there is space on the form to include any special instructions from the patient. And, when a patient with a valid OkPOLST experiences a change in medical condition that creates a situation in which, in reasonable medical judgment, withholding specific healthcare rejected by the OkPOLST will cause or hasten the patient’s death, if the patient is then capable of making decisions affecting healthcare, the attending physician must discuss the situation and treatment with the patient and determine whether, on the basis of information sufficient for informed consent, the patient still wishes the direction in the POLST to control or instead wishes to receive the treatment.

Primary care physicians, long-term care facilities, emergency medical personnel, and hospitals will all be impacted by the arrival of the pink OkPOLST into the healthcare system. More information about the new OkPOLST form can be found at www.okpolst.org/.

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