Massachusetts Medical Orders for Life-Sustaining Treatment

1. Massachusetts Medical Orders for Life-Sustaining Treatment MOLST in Massachusetts: Overview and Expansion Update Following the Patient in the Healthcare Journey MOLST Implementation STAAR/MassPRO Conference Christine McCluskey, RN, MPH Director for MOLST Expansion October 30, 2012

2. The Massachusetts MOLST project is a collaboration of the: Massachusetts Department of Public Health Massachusetts Executive Office of Elder Affairs and Commonwealth Medicine at UMass Medical School 2

3. Objectives • Describe MOLST and its place along the advance care planning continuum • Name steps involved in MA MOLST implementation in health care facilities • List resources for learning more about Medical Orders for Life-Sustaining Treatment

4. MOLST is… • A standardized hot pink-colored form* that contains a patient’s preferences about life-sustaining medical treatments. • Valid medical ordersthat can be honored across all health care settings. • A clinical standard of practice for documenting and communicating patient preferences about life-sustaining medical treatments. • A dynamic form, meant to be updated along with changes in a patient’s health status or treatment preferences. * Original MOLST forms are created on hot pink-colored paper to maximize visibility and portability. Electronic, faxed and non-pink forms are also valid.

5. MOLST in the Advance Care Planning Continuum Everyone age 18 and older Fill out health care proxy form to appoint Health Care Agent C O N V E R S A T I O N S Review/update proxy form periodically Only if diagnosed with an advanced Illness (any age) Fill out a MOLST Form End-of-Life Preferences Communicated and Honored

6. Which patients are suitable for MOLST? Patients of any age with an advanced illness including, but not limited to: • Life-threatening diseases • Chronic progressive diseases • Life-threatening injuries • Medical frailty • Any patient suitable for considering DNR orders

7. MOLST Takeaway Messages • MOLST is not an advance directive. • MOLST is a medical form containing medical orders created by clinicians, based on a patient’s current health condition and effective immediately when signed. • All adults aged 18 and older should still complete a health care proxy form to appoint a health care agent to make decisions for them in the event of loss of capacity.

8. MOLST Expansion in Massachusetts Goal: 2014 Statewide MOLST use 2012-13 June 2012 Spring 2012 2011-12 2010 2008 – 2009 Acts of 2008 mandate and Planning for “POLST” pilot project

9. To launch MOLST in Clinical Care Institutions: • Review MOLST information and resources at www.molst-ma.org. • Identify a “MOLST Clinical Champion” within the institution. • Access the MOLST Implementation Tool Kit at: www.molst-ma.org. • Begin the self-paced MOLST implementation process. • Set or estimate a MOLST launch date and access MOLST forms on line at www.molst-ma.org.

10. Visit the Massachusetts MOLST Website for: • More information about MOLST • Answers to Frequently Asked Questions • MOLST training materials for health professionals • Registration for conference calls and events • Patient and family information and materials • Informative video about MOLST in Massachusetts www.molst-ma.org

11. MOLST Website: molst-ma.org

12. MOLST Video

13. Self Directed Trainings

14. Self Directed Trainings

15. Other Resources POLST website: http://www.ohsu.edu/polst/index.htm MA End of Life Expert Panel: Final Report - Patient Centered Care and Human Mortality http://www.mass.gov/hqcc/the-hcqcc-council/about-the-hcqcc-council/meeting-schedule-and-materials/expert-panel-on-end-of-life-care/