The Realities of Operationalizing MOLST Forms in Emergency Situations

Clemency, Brian M.; Basior, Jeanne M.; Lindstrom, Heather A.; Cordes, Colleen; Waldrop, Deborah P.

doi:10.1016/j.jamda.2016.11.023

Cited by 3 publications

(1 citation statement)

References 11 publications

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“…The lack of a structured discussion or sufficient guidance for completing a POLST paradigm form can lead to incomplete forms, and forms not being completed correctly. A study by Clemency et al (2017) reviewed 100 previously completed POLST paradigm forms that accompanied patients transported to an emergency department in New York. The researchers found that 69 forms had at least one section of orders missing and that 14 forms had contradictory/medically incompatible orders.…”

Section: Limitations Of the Polstmentioning

confidence: 99%

A Video Decision Aid for the West Virginia POST: A Randomized, Controlled Trial

Gallegos¹

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Patients with serious medical conditions are faced with making decisions about treatments related to end-of-life care. The Physician Orders for Life Sustaining Treatment (POLST) is a document that allows patients to express preferences for four medical decisions including cardiopulmonary resuscitation, level of medical intervention, IV fluids, and feeding tubes. Although POLST paradigm forms are used throughout the United States, there is a lack of evidence about the quality of the decision-making process of individuals completing these forms. The use of a decision aid developed for the POLST paradigm could ensure that patients completing these forms are informed, confident, and certain of their treatment decisions. The purpose of the study was to develop and evaluate a video decision aid for the West Virginia POST form. 64 English-speaking, community-dwelling adults (50+), with no evidence of cognitive impairment, were recruited to participate in the study. Participants were randomized to active control (exercise video) or intervention groups (WV POST video). Participants were provided with a clinical vignette that contained medical information for the purpose of making treatment decisions and completing measures included in the study. Participants made decisions for each of the medical decisions contained in the WV POST and completed measures of knowledge, decisional conflict, and satisfaction at pre-and post-intervention. Preliminary analyses identified problems with multicollinearity and the satisfaction variable was removed from final analyses. Separate Multivariate Analysis of Covariance (MANCOVA) analyses were conducted to examine the effect of the video aid on post-intervention ratings of knowledge and decisional conflict, while controlling for numeracy and pre-intervention ratings of decisional outcomes. Chi-Square analyses were conducted to examine the relation between treatment group and participants' decisions for medical treatments. Results identified significant main effects of treatment group for each of the four medical decisions. At post-intervention, participants in the intervention group were more knowledgeable regarding CPR, medical interventions, and IV fluids compared to participants in the control group. Additionally, participants in the intervention group had less decisional conflict related to CPR, medical interventions, IV fluids, and feeding tubes, at post-intervention compared to participants in the control group. Participants who viewed the aid were more satisfied with their CPR, medical interventions, IV fluids, and feeding tube decisions than participants who did not view the aid. There was no significant association between group and medical decision made for any of the four medical decisions in the WV POST. These findings are important because it demonstrates the individuals can be taught necessary information to make an informed decision while completing the WV POST form, and that when using a decision aid, participants feel more informed and less uncertain about their decision. ...

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Section: Limitations Of the Polstmentioning

confidence: 99%

A Video Decision Aid for the West Virginia POST: A Randomized, Controlled Trial

Gallegos¹

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Emergency Medical Services Provider Experiences of Hospice Care

Donnelly¹,

Armstrong²,

Perkins³

et al. 2017

Prehospital Emergency Care

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Elderly patients presenting to a Level I trauma center with Physician Orders for a Life-Sustaining Treatment form: A propensity-matched analysis

Ballou

Dewey

Zonies³

2019

J Trauma Acute Care Surg

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BACKGROUND Physician Orders for Life-Sustaining Treatment (POLST) forms are portable medical orders documenting patient treatment preferences in an acute health decline. It is unclear how these forms are used in the management of elderly trauma patients. METHODS Patients 65 years and older presenting to a Level I trauma center were identified between 2012 and 2017. Hospital trauma registry and medical records were used to identify a preinjury POLST and its acknowledgment by providers within 24 hours of arrival. A 1:1 propensity score matched sample was used to evaluate clinical outcomes based on the presence of a POLST limiting interventions with p less than 0.05 deemed significant. RESULTS There were 3,342 elderly trauma patients identified. One hundred ninety-two (6%) had a POLST identified by the institutional trauma registry dated before the injury. Do not attempt resuscitation (DNR) was listed in 154 patients (80%), and 79% desired to avoid the intensive care unit (ICU) with limited (54%) or comfort measures only (CMO, 25%). One hundred seven (76%) of admitted POLST DNR patients had a DNR code status for the majority of their admission. 59 (58%) of the limited and 29 (60%) of the comfort measures only patients were admitted to the ICU. Acknowledgment of a preinjury POLST or code status was explicitly documented in 110 cases (57%). Propensity score analysis yielded a comparison sample of 288 patients. In the matched comparison, an acknowledged POLST with limitations was associated with a shorter ICU stay (1.7 vs. 2.8 days, p = 0.008) but there was no difference in ICU admission (58% vs. 61%, p = 0.69), total length of stay (3.8 days vs. 4.8 days, p = 0.08), or in-hospital mortality (13% vs. 8%, p = 0.2). CONCLUSION Limited provider acknowledgment of preinjury medical directives necessitates protocol development for the management of frail elderly trauma patients. When acknowledged, patients with a POLST limiting interventions had fewer ICU days without increased in-hospital mortality compared with similarly injured elderly patients. LEVEL OF EVIDENCE Care Management, level IV.

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The Realities of Operationalizing MOLST Forms in Emergency Situations

Cited by 3 publications

References 11 publications

A Video Decision Aid for the West Virginia POST: A Randomized, Controlled Trial

A Video Decision Aid for the West Virginia POST: A Randomized, Controlled Trial

Emergency Medical Services Provider Experiences of Hospice Care

Elderly patients presenting to a Level I trauma center with Physician Orders for a Life-Sustaining Treatment form: A propensity-matched analysis

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