Required Elements of a POLST Paradigm Program

1. Required Elements of a POLST Paradigm Program Bud Hammes, PhD Gundersen Lutheran Health System bjhammes@gundluth.org

2. Why core elements? A POLST Paradigm is a type of clinical intervention. Certain elements are essential in order for the system to be effectively replicated.

3. There are 9 required elements • Form constitutes medical orders. Must be followed by health professionals who provide care across the continuum of care (Requires a signature of physician or other licensed HP and date/time.) • Form is standardized in format, color, and wording.

4. …9 required elements (con’t) • Form is primarily used with patients with advanced, progressive chronic illness, those for whom the “surprise” question answer is “no”, or those who wish to further define their preferences. • Form may be used to limit treatment or to express the desire for full treatment

5. …9 required elements (con’t) • Form provides clear direction about the desired response if the patient is pulseless and apneic. • Form allows for clear directions about other life-sustaining treatment if the patient has serious cardiac or pulmonary problems and expresses instructions regarding the use of artificial nutrition and antibiotics

6. …9 required elements (con’t) • Form transfers with the patient • Health professionals are trained to use the form and to have discussion to complete the form. • Measures are made to monitor the success of the program and its implementation

7. Optional Elements • Signature of patient (or surrogate)* • Reciprocity • Surrogates can complete forms • Some states also have DNR bracelets • Section for basis of order • Order signed by NP or PA • Space to review document *Signature highly recommended by National POLST Paradigm Task Force