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Objectives The POLST (Physician Orders for Life-Sustaining Treatment) program is designed to ensure patients’ treatment preferences are honored by documenting preferences as medical orders. The goal of this study was to evaluate the consistency between treatments provided and POLST orders. Design Retrospective chart abstraction. Setting Stratified, random sample of 90 nursing facilities in Oregon, Wisconsin, and West Virginia. Participants 870 living and deceased nursing facility residents aged 65 and older with a minimum 60-day stay. Measurements Chart data about POLST form orders and related treatments over a 60-day period were abstracted. Decision rules were created to determine whether the rationale for each treatment was consistent with POLST orders. Results Most residents (85.2%) had the same POLST form in place during the review period. A majority of treatments provided to residents with orders for comfort measures only (74.3%) and limited antibiotics (83.3%) were consistent with POLST orders because they were primarily comfort focused rather than life-prolonging. However, antibiotics were provided to 32.1% of residents with orders for no antibiotics. Overall consistency rates between treatments and POLST orders were high for resuscitation (98%), medical interventions (91.1%), antibiotics (92.9%), and modest for feeding tubes (63.6%). In all, POLST orders were consistent with treatments provided 94.0% of the time. Conclusion With the exception of feeding tubes and antibiotic use in residents with orders for no antibiotics, the use of medical treatments was nearly always consistent with POLST orders to provide or withhold life-sustaining interventions. Findings suggest the POLST program is a useful tool for ensuring that the treatment preferences of nursing facility residents are honored.