You may have heard about a new kind of health care directive in Hawaii, called a Provider Orders for Life-Sustaining Treatment (POLST) form. Here, we discuss what a POLST form is and when you need one.
A POLST form is a set of medical orders that helps you keep control over health care at the end of life. Like a Do Not Resuscitate (DNR) order, the form tells emergency medical personnel and other health care providers whether or not to administer cardiopulmonary resuscitation (CPR) in the event of a medical emergency. A POLST form may be used in addition to -- or instead of -- a DNR order. The POLST form may also provide other information about your wishes for end-of-life health care.
A health care professional can help you create a POLST form if you enter a medical facility or health care setting -- such as a hospital, nursing home, or hospice care in a facility or at home. To be legally valid, a POLST form must be signed by a doctor or an advanced practice registered nurse. (Hawaii Statutes § 327K-2.) If a member of the medical staff does not ask you whether you want to create a POLST form, you may ask for one.
In addition to the health care professional's signature, you or your legally appointed health care decisionmaker must sign the POLST form.
In Hawaii, a POLST form is usually printed on bright lime-green paper so it will easily stand out in your medical records. The form travels with you if you move from one health care setting to another. You can change it or cancel it at any time.
A POLST form differs from a DNR order in one important way: A POLST form also includes directions about life-sustaining measures in addition to CPR, such as intubation, antibiotic use, and feeding tubes. The POLST form helps medical providers understand your wishes at a glance, but it is not a substitute for a properly prepared advance health care directive.
A Hawaii advance directive form provides more information than a POLST form, including details about your health care agent, more complete health care wishes, and your preference for organ donation. Therefore, if you have a POLST form, you do not need a DNR order, but you should still complete an advance directive to provide a full set of wishes about your care.
You need to consider a POLST only if you're facing a life-threatening medical condition. If you're healthy, you need only an advance directive to provide a full set of wishes for your treatment in the event of an unexpected accident or medical crisis.
On the other hand, a patient diagnosed with a terminal illness or frailty that requires care in a medical setting -- or ongoing care at home -- may need a POLST in addition to traditional health care directives. That’s because an advance directive may not be enough to prevent medical personnel from resuscitating a patient in an emergency. For that, it's important to have a medical order such as a POLST or DNR order. If you feel strongly that you don’t want emergency measures at the end of life -- or if you’re caring for someone who feels that way -- find out about making a POLST in addition to traditional health care directives.
For details about making an advance directive, see Hawaii Living Wills and Advance Health Care Directives: What You Need to Know.
To learn more, and to view an example of the Hawaii POLST form, visit the website for Hawaii’s hospice and palliative care organization, Kokua Mau. To prepare a POLST form for yourself or a loved one, talk to your doctor.