Polst forms

[johhnybgood]

It seems his own no one ever has a POLST form filled out, despite having metastatic cancer, on chemo with multiple comorbidities. Do family physicians usually do these? To the hospice/pall docs out there, are these something that you do regularly? I typically find these quite useful in my practice, thoughts? But it seems about maybe 10 to 20% of the patients that should have these actually do have these.

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[TooMuchResearch]

Might be a local thing. I find in my patients who should have a POLST probably 60-70% actually have it on file or medics bring a copy from the SNF.

 

[Apollyon]

Just for anyone who might not know, POLST is "Physician Order for Life Saving Treatment". It shares a lot with a living will, but, as is in the name, this one is (or should be) signed by a doctor. It might have a different name in your state.

 

[AlmostAnMD]

Just for anyone who might not know, POLST is "Physician Order for Life Saving Treatment". It shares a lot with a living will, but, as is in the name, this one is (or should be) signed by a doctor. It might have a different name in your state.

Thx

I've never even heard of this, but it might be a state specific thing

 

[gutonc]

Thx

I've never even heard of this, but it might be a state specific thing

It is state specific. That said, all 50 of them have some sort of a POLST/MOLST form.

 

[RustedFox]

Just for anyone who might not know, POLST is "Physician Order for Life Saving Treatment". It shares a lot with a living will, but, as is in the name, this one is (or should be) signed by a doctor. It might have a different name in your state.

Bro, thank you.
I was gonna ask, but you read my damn mind again.

 

[Groove]

If I admit a sick elderly GOMER, I always make a habit to print out a POST form and make them DNR if it's appropriate. I think it's the ultimate colleague courtesy. That way if they code overnight, the night doc doesn't have to respond to a futile code. Most people don't have the foresight to do that but it's so appreciated. There are a few veteran hospitalists in my community hospital that are so good at making patients DNR that they astutely anticipate to suffer a futile code in the next few days. It makes my job so much easier if I'm swing/overnight because all I have to do is respond to pronounce the pt.

 

[dchristismi]

Hospice here. I do them all the time. They're more detailed than DNR and definitely more helpful. They also are more nuanced and tend to flow nicely into or out of a Goals of Care conversation, because 2am in the ED is not the place, nor do you all have the time. Because I know, and I've been there, and that's exactly how I ended up transitioning myself to HPM.

There are plenty of patients and families who feel that a "DNR = giving up," so a POLST is a way to ease into it.

 

[johhnybgood]

Bro, thank you.
I was gonna ask, but you read my damn mind again.

Rusted, you work in land of gomers and don’t know what Polst is? Shame shame.

 

[RustedFox]

Rusted, you work in land of gomers and don’t know what Polst is? Shame shame.

Yeah; that's on me.
DNR forms are easier to spot.

 

[TooMuchResearch]

Yeah; that's on me.
DNR forms are easier to spot.

Scanned advance Care planning docs are very easily accessible for us. Like easy enough that when they bring someone in getting BVM ventilation and they look like they've been old and sick for a long time, I have our staff bag the patient for three minutes so I can peak at the chart and confirm that I should allow the patient to die without any additional pummeling.

 

[gutonc]

Scanned advance Care planning docs are very easily accessible for us. Like easy enough that when they bring someone in getting BVM ventilation and they look like they've been old and sick for a long time, I have our staff bag the patient for three minutes so I can peak at the chart and confirm that I should allow the patient to die without any additional pummeling.

The upside to the POLST is that it's generally available to EMS, so they hopefully don't even get on the bus to come see you.

 

[Apollyon]

Scanned advance Care planning docs are very easily accessible for us. Like easy enough that when they bring someone in getting BVM ventilation and they look like they've been old and sick for a long time, I have our staff bag the patient for three minutes so I can peak at the chart and confirm that I should allow the patient to die without any additional pummeling.

Yeah, but you know what suxx? When they have been bagging with 100% O2, so they certainly don't die in anything near a few minutes.

 

[BoardingDoc]

The upside to the POLST is that it's generally available to EMS, so they hopefully don't even get on the bus to come see you.

Corpse on arrival with CPR in progress:
"They have a form but it's not signed"
"They have a signed DNR but the family said to do everything we could"
"The family member said they're DNR but couldn't find the form"
"The form is literally completed perfectly, confirms DNR/DNI/DNH. Nursing home called us and said to bring them here"

I have had all of these responses verbatim on multiple occasions.

 

[gutonc]

Corpse on arrival with CPR in progress:
"They have a form but it's not signed"
"They have a signed DNR but the family said to do everything we could"
"The family member said they're DNR but couldn't find the form"
"The form is literally completed perfectly, confirms DNR/DNI/DNH. Nursing home called us and said to bring them here"

I have had all of these responses verbatim on multiple occasions.

Yeah...I know it's not a silver bullet. But hopefully it helps a bit.