A Comparison of Methods to Communicate Treatment Preferences in Nursing Facilities: Traditional Practices Versus the Physician Orders for Life‐Sustaining Treatment Program

Hickman, Susan E.; Nelson, RN Christine A.; Perrin, Nancy; Moss, Alvin H.; Hammes, Bernard J.; Tolle, Susan W.

doi:10.1111/j.1532-5415.2010.02955.x

Cited by 176 publications

(185 citation statements)

References 30 publications

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“…POLST captures preferences concerning cardiopulmonary resuscitation, overall aggressiveness of care, hospital transfer, and artificial nutrition. 1 The document is particularly useful for residents of nursing facilities because many residents live in compromised health states and would not desire burdensome treatments 2 and also because it is common for nursing home residents to transition to the emergency room and the hospital 3 where resuscitation and end of life treatments can be guided by the POLST.…”

Section: Introductionmentioning

confidence: 99%

Use of the Physician Orders for Life-Sustaining Treatment among California Nursing Home Residents

Jennings

Zingmond²,

Louie³

et al. 2016

J GEN INTERN MED

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BACKGROUND: Physician Orders for Life-Sustaining Treatment (POLST) is a tool that facilitates the elicitation and continuity of life-sustaining care preferences. POLST was implemented in California in 2009, but how well it disseminated across a large, racially diverse population is not known and has implications for end-of-life care. OBJECTIVE: To evaluate the use of POLST among California nursing home residents, including variation by resident characteristics and by nursing home facility. DESIGN: Observational study using California Minimum Data Set Section S. PARTICIPANTS: A total of 296,276 people with a stay in 1,220 California nursing homes in 2011. MAIN MEASURES:The proportion of residents with a completed POLST (containing a resuscitation status order and resident/proxy and physician signatures) and relationship to resident characteristics; change in POLST use during 2011; and POLST completion and unsigned forms within nursing homes. KEY RESULTS: During 2011, POLST completion increased from 33 to 49 % of California nursing home residents. Adjusting for age and gender using a mixed-effects logistic model, long-stay residents were more likely than short-stay residents to have a completed POLST [OR = 2.36 (95 % CI 2.30, 2.42)]; severely cognitively impaired residents were less likely than unimpaired to have a completed POLST [OR = 0.89 (95 % CI 0.87, 0.92)]; and there was little difference by functional status. There was no difference in POLST completion among White non-Hispanic, Black, and Hispanic residents. Variation in POLST completion among nursing homes far exceeded that attributable to resident characteristics with 40 % of facilities having ≥80 % of long-stay residents with a completed POLST, while 20 % of facilities had ≤10 % of long-stay residents with a completed POLST. Thirteen percent of nursing home residents had a POLST containing a resuscitation preference but lacked a signature, rendering the POLST invalid. CONCLUSIONS: Statewide nursing home data show broad uptake of POLST in California without racial disparity. However, variation in POLST completion among nursing homes identifies potential areas for quality improvement.KEY WORDS: end-of-life care; nursing home; long-term care; quality improvement. J Gen Intern Med 31(10):1119-26 DOI: 10.1007/s11606-016-3728-9 © Society of General Internal Medicine 2016 INTRODUCTIONPhysician Orders for Life-Sustaining Treatment (POLST) facilitates elicitation of life-sustaining treatment preferences from patients and is designed to improve the transition of these preferences, in the form of physician orders, across care settings. POLST captures preferences concerning cardiopulmonary resuscitation, overall aggressiveness of care, hospital transfer, and artificial nutrition. 1 The document is particularly useful for residents of nursing facilities because many residents live in compromised health states and would not desire burdensome treatments 2 and also because it is common for nursing home residents to transition to the emergency room and the hospital 3 wh...

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Section: Introductionmentioning

confidence: 99%

Use of the Physician Orders for Life-Sustaining Treatment among California Nursing Home Residents

Jennings

Zingmond²,

Louie³

et al. 2016

J GEN INTERN MED

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“…3 A study of hospice patients found a high rate of consistency between treatments provided and POLST orders. 4 A recent retrospective study 5 compared the use of POLST with the standard approach of writing medical orders for 1711 long-term care residents in three states. Looking only at POLST use in these nursing homes, this study determined that residents with POLST forms had significantly more medical orders regarding life-sustaining treatment than residents without POLST forms.…”

mentioning

confidence: 99%

The POLST Program: A Retrospective Review of the Demographics of Use and Outcomes in One Community Where Advance Directives Are Prevalent

Hammes

Rooney

Gundrum

et al. 2012

Journal of Palliative Medicine

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Objectives: Determine the use and utility of the Physician Orders for Life-Sustaining Treatment (POLST) program in a community where powers of attorney for health care (POAHCs) are prevalent. Methods: A retrospective review of medical record and death certificate data of 400 adults who died between September 1, 2007, and March 31, 2008, in the La Crosse County, Wisconsin community. Demographic and cause-of-death data were collected from death certificates. Information about POAHC, POLST forms, and medical treatments provided in the last 30 days of life were abstracted from decedents' medical records. Results: Sixty-seven percent of decedents had a POLST form, whereas 22% had POAHC alone. In comparison with decedents with POAHC alone, decedents with a POLST form were significantly older (83 versus 77 years, p < 0.001), more likely to die in a nursing home than in a hospital ( p < 0.001), and more likely to die from a terminal or chronic illnesses (97%). Decedents with POLST orders for higher levels of medical treatment received more treatment, and in only two cases was there evidence that treatment was discrepant with POLST orders. In 31% of all POLST forms, the person appointed in the POAHC consented to the POLST orders. Conclusions: POLST can be a highly effective program to ensure that patient preferences are known and honored in all settings. POAHCs are valuable because they identify appropriate surrogates when patients are incapacitated.

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“…First, the use of standard fields or standardized orders can increase the completeness and improve the clarity of code status documentation. 22,23 For institutions with an electronic medical record, forcing functions may further increase code status documentation. One study found that the implementation of an electronic medical record increased code status documentation from 4% to 63%.…”

Section: Discussionmentioning

confidence: 99%

Frequency and clinical relevance of inconsistent code status documentation

Weinerman

Dhalla

Kiss

et al. 2015

Journal of Hospital Medicine

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BACKGROUND Accurate and complete documentation of hospitalized patients' code status is important to ensure that healthcare providers take appropriate action in the event of a cardiac arrest. OBJECTIVE Determine the frequency and clinical relevance of incomplete and inconsistent code status documentation. DESIGN Point‐prevalence study. SETTING Academic medical centers. PATIENTS Patients admitted to general internal medicine wards. MEASUREMENTS Frequency and clinical relevance of inconsistent code status documentation across 5 documentation sources. RESULTS Thirty‐eight (20%; 95% confidence interval [CI], 14%‐26%) of 187 patients had complete and consistent code status documentation. Another 27 (14%; 95% CI, 9%‐19%) patients had no code status documentation. The remaining 122 (65%; 95% CI, 58%‐72%) patients had at least 1 code status documentation inconsistency. Of these, 38 (20%; 95% CI, 14%‐26%) patients had a clinically relevant code status documentation inconsistency. Multivariate logistic regression analysis demonstrated that increased age (odds ratio [OR] = 1.07 [95% CI, 1.05‐1.10] for every 1‐year increase in age, P < 0.001) and patients receiving comfort measures (OR = 9.39 [95% CI, 1.35–65.19], P = 0.02) were independently associated with a clinically relevant code status documentation inconsistency. CONCLUSIONS Incomplete and inconsistent documentation of code status occurred frequently in hospitalized patients, especially elderly patients and patients receiving comfort measures. Having multiple, poorly integrated code status documentation sources leads to a significant number of concerning inconsistencies that create opportunities for healthcare providers to inappropriately deliver or withhold resuscitative measures that conflict with patients' expressed wishes. Institutions need to be aware of this potential documentation hazard and take steps to minimize code status documentation inconsistencies. Journal of Hospital Medicine 2015;10:491–496. © 2015 Society of Hospital Medicine

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A Comparison of Methods to Communicate Treatment Preferences in Nursing Facilities: Traditional Practices Versus the Physician Orders for Life‐Sustaining Treatment Program

Cited by 176 publications

References 30 publications

Use of the Physician Orders for Life-Sustaining Treatment among California Nursing Home Residents

Use of the Physician Orders for Life-Sustaining Treatment among California Nursing Home Residents

The POLST Program: A Retrospective Review of the Demographics of Use and Outcomes in One Community Where Advance Directives Are Prevalent

Frequency and clinical relevance of inconsistent code status documentation

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