The Indiana POST Program: An Overview

1. The Indiana POST Program: An Overview

2. The POST Program • POST = Physician Orders for Scope of Treatment • Converts treatment preferences into immediately actionable medical orders • Preferences to have or decline treatments • Transfers across treatment settings with patient • Recognizable, standardized form

4. POST Paradigm Programs Dark pink = endorsed Light pink = developing White = no activity Source: www.polst.org

5. Research on POST • POST supports patient-centered care by expanding beyond DNR/full code orders (Hammes et al., 2012; Hickman et al., 2004; 2009) • POST is more effective than traditional approaches at ensuring treatment preferences are documented as orders (Hickman et al., 2010); • POST orders do change the kinds of treatments patients receive (Hickman et al., 2010); • Treatments provided are largely consistent with POST orders (Hickman et al., 2011); • POST is viewed as helpful by clinicians including EMTs and hospice personnel (Schmidt et al., 2004; Hickman et al., 2009)

6. The Indiana POST Program • Indiana Patient Preferences Coalition • Mission: To develop a standardized tool to record patient wishes as medical orders that transfer across treatment settings with a goal of honoring individual preferences for care. • Membership of 60+ representing key stakeholder groups

7. Legislative History • 2012 Session - HB 1114 • Did not make it out of committee • 2013 Session - HB 1182 • Passed Indiana House 99-0 • Passed Indiana Senate 48-1 with amendments • Concurrence passed 95-0 • Signed into law (IC

8. Who can have a POST? • Must have one (or more) of the following conditions: • An advanced chronic progressive illness • An advanced chronic progressive frailty • Note: Frailty is a medical diagnosis • A terminal condition • Unlikely to benefit from CPR • Would the patient’s physician be surprised if the patient died within the next 12 months?

9. Who can fill out a POST form with a patient? • Physician or his/her designee (TBD by physician) • Requires physician signature to execute the order • Physician must provide license number, address, and phone number • Form must be signed by the patient or their legally authorized representative

10. What if the patient lacks decisional capacity? • A POST form can be filled out based on a conversation with: • An appointed health care representative; • An individual's attorney in fact with authority to consent to or refuse health care for the individual; • A legally appointed guardian (includes parents of minor) • Decisions must be based on prior known wishes or best interest of patient

11. How does the POST work in the hospital setting? • POST is valid in ALL settings • Should follow in emergency department setting unless orders appear invalid or alternative treatment is requested by patient/representative • Admission orders should be consistent with POST orders • POST orders should be used to guide treatment decisions including level of aggressiveness of intervention in hospital • Individual hospitals should develop policies and procedures re POST