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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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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