An Oregon program of medical orders created to ensure critically ill patients’ wishes are respected is rapidly being adopted by other states across the nation. In the past month two states, California and New York, have both enacted their own versions of the Physicians Orders for Life Sustaining Treatment (POLST) program.
California Gov. Arnold Schwarzenegger signed his state’s legislation into law on August 5th. New York signed its legislation into effect July 8. At this point, 23 states - including Oregon, Washington, Pennsylvania, Wisconsin, and West Virginia - have either adopted the program or are developing the program in certain regions or statewide.
The POLST program was first conceived in 1991 by a group of Oregon health care professionals. They identified the need for a system to ensure patients with advanced illness and frailty are able to have medical orders to direct their health care. The goal is to be sure that no matter where patients receive care, their treatment wishes will be respected. The result of these discussions was the development of the POLST Program.
At the center of the program is the brightly colored medical order sheet. In Oregon, it is neon pink, while in Washington, it is bright green. The POLST form is completed and signed by the health care professional in consultation with the patient. It provides medical orders to guide doctors, nurses and EMS workers stating whether specific medical interventions are to be used in a time of crisis such as use of a breathing machine. The highly-visible medical order form stays with the patient at home or with their medical chart in a nursing home. The form also accompanies the patient if they go to the hospital so that the orders can be found and acted on if needed.
“Some patients with advanced illness want to receive all available medical interventions. Others choose some medical interventions while refusing others. The important thing is that the POLST program turns patient wishes into action with medical orders. Emergency medical personnel are required to provide all medical treatment unless they have written medical orders to the contrary,” said Patrick Dunn, M.D., Chair of the National POLST Paradigm Task Force and Director of Ethics Education at Oregon Health & Science University.OHSU’s ethics center played a pivotal role in helping to develop, test and refine the POLST program. OHSU also administers Oregon’s program on an ongoing basis and serves as the national coordinating center to other states.
“Other states are following Oregon’s lead because the POLST program has proven to be so effective in ensuring patient wishes to have or to limit treatment are respected,” said Susan Tolle, M.D., Director for the Center for Ethics in Health Care at OHSU.
Additional information about the use of POLST-like programs in other states can be found by visiting www.POLST.org
Oregon Health & Science University is the state’s only health and research university, and Oregon’s only academic health center. OHSU is Portland's largest employer and the fourth largest in Oregon (excluding government), with 12,400 employees. OHSU's size contributes to its ability to provide many services and community support activities not found anywhere else in the state. It serves patients from every corner of the state, and is a conduit for learning for more than 3,400 students and trainees. OHSU is the source of more than 200 community outreach programs that bring health and education services to every county in the state.