A new national report out this fall highlights the success of the Physicians Orders for Life Sustaining Treatment (POLST) program and, more specifically, the program’s most recent collaboration. The report, titled Pathways to POLST Registry Development: Lessons Learned, will be released Monday, Oct. 1, and highlights the use of POLST registries to ensure that medical orders are available in a time of crisis. The report is being published by the POLST Paradigm Task Force, which guides states as they develop their own programs.
Oregon health care professionals created POLST two decades ago in an effort to ensure the wishes of those with advanced illness or frailty are followed. The program's key component is a bright pink medical order form that provides clear instruction about the patient's treatment preferences to health professionals, such as paramedics and emergency room physicians, when a patient cannot communicate these wishes themselves.
The form allows patients to request or refuse certain measures such as CPR or intensive care. In the past 20 years, POLST programs have been adopted or are in development in 43 states across the country to improve communication between patients and families and all of the health care professionals caring for them.
The latest innovation of POLST programs nationwide has been the development of POLST registries. These are secure electronic databases that provide 24/7 access to these medical orders for emergency medical providers in a time of crisis when patient is unable to communicate for him/herself.
Highlights from the report and additional sources:
- More than 100,000 forms have been entered into the Oregon POLST Registry since launch in December 2009.
- On average, the registry receives 3,500 to 4,000 new POLST forms per month.
- Since its launch, the registry has received more than 1,500 calls from hospitals and emergency medical providers.
- About half of those calls (47 percent) are coming from Oregon emergency physicians throughout the state.
- The remaining calls come from emergency medical responders (34 percent) and acute care units (17 percent).
- Every county in the state of Oregon participates in the POLST program.
- Every hospital, hospice program, and nursing facility in the state participates in the POLST program.
The report also contains information about other states that have created or are considering registries or other electronic POLST solutions, including West Virginia, Idaho, Utah, New York, Washington and California.
“The creation of the POLST program itself was revolutionary,” said Dana Zive, senior scholar with the OHSU Center for Ethics in Health Care and author of the report. “Once we learned that up to 25 percent of the time POLST forms were not immediately available, the next logical step was to build a registry. We remain surprised by how quickly the registry has expanded to better serve patients who enroll in the program.”
“The Oregon registry has helped West Virginia develop its registry every step of the way,” said Alvin (Woody) Moss, director of West Virginia's POLST program, and contributing editor for the report. “Oregon has generously shared policies, procedures and lessons learned. Oregon has done the hard conceptual work. Other states like West Virginia will benefit from their pioneering efforts.”
About the Oregon POLST registry
The Oregon POLST registry was created and funded by the Oregon Legislature through the passage of House Bill 2009 on July 1, 2009. The legislation created the registry within the Oregon Health Authority (OHA). The registry is contractually operated for the OHA by the Department of Emergency Medicine at OHSU.