July 20, 2012_NH "Dear Administrator" Letters

July 20, 2012

ADSA: NH #2012-008
PHYSICIAN ORDERS FOR LIFE SUSTAINING TREATMENT (POLST)

Dear Nursing Home Administrator:

Recently, we have received several questions from staff and providers on physician orders for life sustaining treatment (POLST) form.  The purpose of this letter is to remind you of the requirements and provide guidance on this issue.

Here is some key information on POLST:

  • A POLST form is a way of summarizing wishes of an individual regarding life-sustaining treatment.  It is not an advance directive; it is a physician's order that was designed for Emergency Medical personnel use only.  
  •  In the short term, the POLST form can provide guidance regarding a resident's end of life choices until additional advance directive information is obtained.
  • An advance directive refers to a resident's oral and written instructions about their future medical care in the event a resident is unable to express their medical wishes.  An advance directive is not required for having a POLST form.
  • State law, (chapter 7.70 RCW) provides everyone with the right to be fully informed of health care issues that have the potential to affect their lives.  RCW 7.70.050 allows a provider to implement an advance directive in good faith if, in an emergency, the provider cannot obtain an informed consent decision due to the incompetence of the resident or the unavailability of the legal decision maker. 
  • Nursing homes are required to have policies and procedures on health care decision making and directing staff how to handle a resident's advance directives (WAC 388-97-1780 and WAC 388-97-0280).  The policies and procedures should also include what staff can do with and about a POLST form.
  • Unless staff are a licensed medical or nursing professional, they likely do not have the scope of practice to evaluate the situation or implement the individual's advance directive. 
  • Since the POLST is intended for emergency medical personnel, there are issues related to legal immunity for others to follow the POLST directions.  In addition, some assessment and decisions about end-of-life issues may only be made by a licensed practitioner. For these specific situations, you may want to consult your attorney for legal advice.

Here are other resources available to learn about POLST:

Fact sheets on POLST, advanced directives and informed consent are available on the ADSA NH professional page at https://www.dshs.wa.gov/altsa/residential-care-services/information-nursing-home-professionals under the heading "Health Care Decision Making"; and

The Department of Health web page at: https://www.doh.wa.gov/YouandYourFamily/IllnessandDisease/PhysiciansOrdersforLifeSustainingTreatment; and 

The Washington State Medical Association answers Frequently Asked Questions (FAQs) at https://wsma.org/wcm/Patients/Wellness_Report/Wellness_Report_Articles/POLST__Further_protection_for_the_seriously_ill_or_those_facing_the_end_of_life.aspx.

Please call your RCS Field Manager if you have any questions about the use of the POLST form.

Sincerely,

Joyce Pashley Stockwell, Director
Residential Care Services