TY - JOUR
T1 - Physician Orders for Life-Sustaining Treatment (POLST)
T2 - Lessons learned from analysis of the Oregon POLST Registry
AU - Schmidt, Terri A.
AU - Zive, Dana
AU - Fromme, Erik K.
AU - Cook, Jennifer N.B.
AU - Tolle, Susan W.
N1 - Funding Information:
The authors wish to disclose that the Oregon POLST Registry is operated within the OHSU Department of Emergency Medicine under contract with the State of Oregon. Authors Schmidt T, Zive D, and Cook J received salary support for Registry operations, but not for research activities. Authors Fromme E, Zive D, and Cook J received research support through a grant from Samuel S. Johnson Foundation, during the conduct of the study; Fromme E. and Zive D. report travel support from the Oregon POLST Program, Center for Ethics in Health Care at OHSU; and grants from the California Coalition for Compassionate Care. Susan Tolle received support for her national leadership of the POLST Program from the Retirement Research Foundation, the California HealthCare Foundation and the Archstone Foundation. Cook J. received personal fees from Continuing Medical Education of Southern Oregon, and from Washington County EMS, outside the submitted work.
PY - 2014/4
Y1 - 2014/4
N2 - Background: Physician Orders for Life-Sustaining Treatment (POLST) has become a common means of documenting patient treatment preferences. In addition to orders either for Attempt Resuscitation or Do Not Attempt Resuscitation, for patients not in cardiopulmonary arrest, POLST provides three levels of treatment: Full Treatment, Limited Interventions, and Comfort Measures Only. Oregon has an electronic registry for POLST forms completed in the state. We used registry data to examine the different combinations of treatment orders. Methods and results: We analyzed data from forms signed and entered into the Oregon POLST Registry in 2012. The analysis included 31,294 POLST forms. The mean Registrant age was 76.7 years. 21,396 (68.4%) had Do Not Attempt Resuscitation (DNR) orders and 9900 (31.6%) had orders for "Attempt Resuscitation". The 6 order combinations were: Do Not Resuscitate (DNR)/Comfort Measures Only 10,769 (34.4%), DNR/Limited Interventions 9306 (29.7%), DNR/Full Treatment 1211 (3.9%), Attempt Cardiopulmonary Resuscitation (CPR)/Comfort Measures Only 11 (0.04%), Attempt CPR/Limited Interventions 2281 (7.3%), and Attempt CPR/Full Treatment 7473 (23.9%). Conclusions: The most common order combinations were DNR/Comfort Measures Only, DNR/Limited Interventions and Attempt Resuscitation/Full Treatment. These three makes sense to health professionals. However, other order combinations that require interpretation at the time of a crisis were completed for about 10% of Registrants. These combinations need further investigation.
AB - Background: Physician Orders for Life-Sustaining Treatment (POLST) has become a common means of documenting patient treatment preferences. In addition to orders either for Attempt Resuscitation or Do Not Attempt Resuscitation, for patients not in cardiopulmonary arrest, POLST provides three levels of treatment: Full Treatment, Limited Interventions, and Comfort Measures Only. Oregon has an electronic registry for POLST forms completed in the state. We used registry data to examine the different combinations of treatment orders. Methods and results: We analyzed data from forms signed and entered into the Oregon POLST Registry in 2012. The analysis included 31,294 POLST forms. The mean Registrant age was 76.7 years. 21,396 (68.4%) had Do Not Attempt Resuscitation (DNR) orders and 9900 (31.6%) had orders for "Attempt Resuscitation". The 6 order combinations were: Do Not Resuscitate (DNR)/Comfort Measures Only 10,769 (34.4%), DNR/Limited Interventions 9306 (29.7%), DNR/Full Treatment 1211 (3.9%), Attempt Cardiopulmonary Resuscitation (CPR)/Comfort Measures Only 11 (0.04%), Attempt CPR/Limited Interventions 2281 (7.3%), and Attempt CPR/Full Treatment 7473 (23.9%). Conclusions: The most common order combinations were DNR/Comfort Measures Only, DNR/Limited Interventions and Attempt Resuscitation/Full Treatment. These three makes sense to health professionals. However, other order combinations that require interpretation at the time of a crisis were completed for about 10% of Registrants. These combinations need further investigation.
KW - Advance care planning
KW - Emergency Medical Services (EMS)
KW - POLST
KW - Registries
KW - Resuscitation orders
KW - Scope of treatment
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U2 - 10.1016/j.resuscitation.2013.11.027
DO - 10.1016/j.resuscitation.2013.11.027
M3 - Article
C2 - 24407052
AN - SCOPUS:84895924196
SN - 0300-9572
VL - 85
SP - 480
EP - 485
JO - Resuscitation
JF - Resuscitation
IS - 4
ER -