One of the most common desires of people with serious advanced illness is to be allowed to stay at home and avoid aggressive treatments. Often, a Do Not Resuscitate order is in effect as per the person’s wishes. However, this can get confusing in the event of a fall, minor stroke, choking episode or chest pain. Does the family or caregiver call 911? Can the emergency service providers help if there is a Do Not Resuscitate order? This is where POLST fills the gap.
POLST stands for Physicians’ Orders for Life Sustaining Treatment. The POLST is a set of medical orders that directs emergency service providers to offer either limited, comfort, or full resuscitative care in an emergency. It is for the frail, or chronically ill person whose death could come within a year or so but who experiences a medical problem and needs more than the family or caregiver can provide.
As part of the POLST, you choose the level of care that suits you best, whether it is comfort, limited, or full resuscitative. Here’s what each level entails.
Comfort care includes: medications, positioning, wound care, and other measures to relieve pain and discomfort. Oxygen or suction may be used as needed. Transfer to a hospital occurs only if comfort measures cannot be accomplished at the current location.
Limited care includes: comfort measures, intravenous (IV) fluids, cardiac monitoring, and non-invasive airway support. A transfer to the hospital is avoided unless comfort cannot be achieved.
Full resuscitative measures can include: intubation or ventilation to help you breathe, chest compressions, IV’s, and transfer to the nearest hospital emergency room or intensive care unit.
The POLST is obtained from and signed by a healthcare provider and can override protocols that would otherwise require full resuscitative measures including automatic transfer to the hospital for evaluations. POLST is portable and stays with you in your residence whether that is at home, a nursing home or hospital.
If you believe you could benefit from a POLST form, talk to your providers. For more information about POLST, contact the Visiting Nurse Home Care and Hospice at 603-356-7006 or visit the Advance Care Planning section of their website at www.vnhch.org.