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POLST Research and Evaluation

POLST Research Studies. POLST in Long-Term Care SettingsNo one received unwanted CPR, ICU care, or ventilator support (Tolle et al., 1998)Treatment matched POLST instructions regarding CPR (91%) antibiotics (86%), IV fluids (84%), feeding tubes (94%), and medical interventions (46%)20% received m

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POLST Research and Evaluation

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    1. POLST Research and Evaluation Susan Hickman, PhD OHSU School of Nursing hickmans@ohsu.edu

    2. POLST Research Studies POLST in Long-Term Care Settings No one received unwanted CPR, ICU care, or ventilator support (Tolle et al., 1998) Treatment matched POLST instructions regarding CPR (91%) antibiotics (86%), IV fluids (84%), feeding tubes (94%), and medical interventions (46%) 20% received more invasive medical interventions (Lee et al., 2000)

    3. POLST Research Studies POLST in Long-Term Care Settings POLST accurately conveys treatment preferences 90% of time (Meyers et al., 2004) Resuscitation status does not indicate preferences (Hickman et al., 2004) 77% with DNR had order for more than the lowest level of treatment in at least one other category. 47% with full code had orders for less than the highest level of treatment in at least one other category

    4. POLST Research Studies POLST in Long-Term Care Settings POLST RO1 Telephone survey findings from OR, WI, WV Chart review of n = 1793 records in 90 facilities

    5. POLST Research Studies POLST and EMS POLST changed treatment in 45% of cases 91% agreed POLST is useful in determining what to do when patient pulseless, apneic (Schmidt et al., 2004) University of Washington, Vancouver grad student looking at use in emergency department and when deviate from POLST

    6. POLST Research Studies POLST in Hospice Hickman et al preliminary data Telephone survey in WI, OR, WV Chart review

    7. POLST Quality Indicators Is the POLST where it should be? Presence/absence Location Single versus multiples Arrives with patient Returns with patient

    8. POLST Quality Indicators Is it filled out correctly? More than one box per section? Inconsistencies in orders? Signed by MD/NP/PA? Signed by patient/surrogate? Consistent with existing advance directive? Based on conversation? Updated properly?

    9. POLST Quality Indicators Is the system working as a system? Are orders honored? EMS protocols address POLST? EMTs follow POLST? How generated in long-term care? How used in emergency department? Used by hospice?

    10. POLST Quality Indicators Attitudes towards POLST EMS comfortable honoring orders? Used by nursing facilities? Why or why not? MDs on board? Patients and families comfortable?

    11. Evaluation Resources National POLST Paradigm Task Force www.polst.org Adaptation of research tools Attitudes survey Telephone usage survey Methods for chart review

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