Learn About the POLST Clinical Document Architecture Standard in Upcoming Webinar
National POLST is presenting a webinar titled “Making Sense of the New POLST Clinical Document Architecture (CDA) Standard” on January 26, 2023, at 3 pm ET. The webinar will be presented by Abby L. Dotson, PhD, director of the Oregon POLST Registry and research assistant professor at OHSU Emergency Medicine; Robert M. Cothren, PhD, consultant to the Coalition for Compassionate Care of California; and Kelly Thompson of Lexis Nexis Special Services. More information is in the attached flyer. To register, contact Monique Tyler at mtyler@lhcqf.org.
Pennsylvania Legislation Update
Pennsylvania State Senator Gene Yaw (R - District 23) announced that he will be reintroducing POLST legislation, previously SB 572 of the 2021–22 session, in the Pennsylvania Senate. The legislation will update and revise Pennsylvania law (Title 20) to include the codification of "Pennsylvania Orders for Life Sustaining Treatment (POLST)" to be used by medical professionals across all healthcare settings for patients who voluntarily wish to execute a POLST order. More information is available here.
PA POLST On-Demand Learning Modules Now Available—With Free CE!
The updated and redesigned POLST continuing education modules are now available for on-demand learning. These modules provide an interactive learning opportunity for practitioners seeking to enhance their ability to have POLST conversations with patients. A multidisciplinary statewide POLST Curriculum Committee participated in the development of these modules, which cover the following topics:
Module 1 - Introduction to POLST(2.5 CME or CNE credits): Highlights the differences between Advance Directives and POLST, critical aspects of the POLST form, and how to master POLST conversations with patients and their support teams.
Module 2 - Overview of POLST and Advance Directives(1.5 CME or CNE credits): Explores the necessity of advance care planning and the function of the POLST document, the Out-of-Hospital DNR, critical elements of a POLST discussion, how to complete a POLST form appropriately, and the necessary components for POLST implementation.
Module 3 - POLST Conversations(1.5 CME or CNE credits): Provides strategies to improve skill and comfort with having POLST conversations, including techniques for having effective conversations and promoting informed decision making for patients and families.
Module 4 - POLST Tools (0.5 CME or CNE credits): Provides tools to facilitate effective POLST conversations, including critical discussion points and helpful phrases for POLST conversations and cultural and spiritual awareness.
Module 5 - POLST Implementation(1.5 CME or CNE credits): Explores the essential components of a successful POLST implementation, including recommended policy and procedures and quality indicators to evaluate appropriate POLST use.
Module 6 - Medicare Reimbursement for Advance Care Planning Discussions(0.5 CME or CNE credits): Reviews Medicare reimbursement criteria and codes for advance care planning and POLST conversations with patients.
Module 7 - Carousel Cases (0.5 CME or CNE credits): Presents case-based scenarios to facilitate the practice of crucial POLST conversation points.
Emergency Medical Services and POLST (0.5 CME or CNE credits): Reviews Pennsylvania’s Advance Directive law and provides an overview of the role of EMS personnel in POLST, as well as guidance in identifying the differences between Out-of-Hospital DNR and POLST documentation.
Pediatric POLST and EMS (Coming Soon!) (1.0 CME or CNE credits): Provides an overview of the considerations for use of POLST and the role of EMS personnel in POLST in pediatric populations, as well as guidance in identifying the differences between Out-of-Hospital DNR and POLST documentation for pediatric patients.
Cultural Competency and POLST (Coming Soon!)
These self-paced modules are now available in the new POLST Learning Center at www.papolst.org/learning-center. There is no cost for the continuing education credits.
This project was supported by a grant from the McElhatten Foundation to enhance access to POLST education and resources for healthcare providers and personnel throughout Pennsylvania.
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POLST Legislation Signed into Massachusetts Law
Massachusetts Governor Charlie Baker signed Bill H.5374 “An Act Relating to Economic Growth and Relief for the Commonwealth,” which included language authorizing the Executive Office of Elder Affairs to lead and administer the updating of the current Massachusetts MOLST program to a POLST (Portable Orders for Life Sustaining Treatment) program aligned with national standards, including the development of a POLST e-Registry. The Massachusetts Coalition for Serious Illness Care has been working on this legislation since 2018. Key components of the new program include training and education for clinicians and care teams; education for patients, families, caregivers, and legal advocates; and immediate access to POLST orders via an electronic registry available 24/7, which is of particular importance to first responders, who require signed orders to provide selective or comfort-focused treatments. Information on the program transition is available online.
From the Literature
Effectiveness of Advance Care Planning: What Works, What Doesn’t, and What Needs to Change?
A paper by Drs. Susan Tolle and Katrina Hedberg was recently published in The Journal of Clinical Ethics. In this article, the authors discussed the importance of goals-of-care conversations, a specific plan, and necessary supports to achieve patients’ goals for end-of-life care. The abstract is available online (subscription required to access full text).
Reasons for Discordance Between Life-Sustaining Treatment Preferences and Medical Orders in Nursing Facilities Without POLST
Nursing facilities that do not have POLST programs have been shown to have greater discordance between patient preferences for end-of-life care and medical orders. An article from the American Journal of Hospice and Palliative Care examines the reasons for this misalignment of patient wishes and documented orders for life-sustaining treatment and highlights the importance of structured documentation strategies such as POLST to ensure documentation of conversations around end-of-life care wishes. The abstract is available online (subscription required to access full text).
