This post is based on a session I attended at the Iowa Governor’s Conference on Public Health in April 2013 by by Stephanie Anderson, MSN, RN, CHPN & Christine Harlander, RN, BSN, CHPN. For More posts from the Governor’s Conference, click here. The Presentation Slides can be found here.
This next session I attended at the Governor’s conference on Public Health was based on POLST (physician orders for life-sustaining treatment). While this topic, of signing a form that is similar to a DNR and requesting final wishes, is not related to my work, many of the topics they used to spread the word for their program.
Advanced directives are living wills that talk about hypothetical situation and power of attorney to be your voice. It however does not have a DNR order. In order to enact this advanced directive, you must be in the final year of life or have a documented terminal disease.
With the DNR/Living will program, many patients get more aggressive care than desired.
POLST includes a specific, informed, decision making process under the care of a physician. The process includes difference decisions in different circumstances. POLST does not require terminal status or have age restrictions. In Iowa, they also made sure that the POLST form could cross healthcare settings, even with HIPAA regulations.
There is no POLST program/form in Kansas or Missouri.
For more about their strategy to spread the POLST form…
The goal is a standardized, systematic model that can be implemented in many ways yet maintain integrity of process
- ID Champion – at least one. Consider one admin and one physician per community
- Establish Community Coalition – ID key stakeholders for inclusive community membership. Champions should participate on coalition. Coalition drives operations, education and oversight. This is a short term group that will be dynamic. The members should stay mostly the same, pulling in new when necessary, but timing and necessity of meetings will change as needed. Public health agencies being aware of the program as a champion or just informed party – can help to gain awareness of the program.
- Train those having conversations – Train the Trainer with (certified) facilitators and instructors. Respecting Choices is the education program they use. For example, the presenters are trainers who train instructors.
- Educate healthcare providers – providers must be certified to do the forms.