TY - JOUR
T1 - Use of the physician orders for life-sustaining treatment program in Oregon nursing facilities
T2 - Beyond resuscitation status
AU - Hickman, Susan E.
AU - Tolle, Susan W.
AU - Brummel-Smith, Kenneth
AU - Carley, Margaret Murphy
N1 - Copyright:
Copyright 2008 Elsevier B.V., All rights reserved.
PY - 2004/9
Y1 - 2004/9
N2 - OBJECTIVES: Program was designed to communicate resident/surrogate treatment preferences in the form of medical orders. To assess statewide nursing facility use of the Physician Orders for Life-Sustaining Treatment (POLST) and to identify the patterns of orders documented on residents' POLST forms. DESIGN: Telephone survey; on-site POLST form review. SETTING: Oregon nursing facilities. PARTICIPANTS: One hundred forty-six nursing facilities in the telephone survey; 356 nursing facility residents aged 65 and older at seven nursing facilities in the POLST form review. MEASUREMENTS: A telephone survey; onsite POLST form reviews. RESULTS: In the telephone survey, 71% of facilities reported using the POLST program for at least half of their residents. In the POLST form review, do-not-resuscitate (DNR) orders were present on 88% of POLST forms. On forms indicating DNR, 77% reflected preferences for more than the lowest level of treatment in at least one other category. On POLST forms indicating orders to resuscitate, 47% reflected preferences for less than the highest level of treatment in at least one other category. The oldest old (≥85, n = 167) were more likely than the young old (65-74, n = 48) to have orders to limit resuscitation, medical treatment, and artificial nutrition and hydration. CONCLUSION: The POLST program is widely used in Oregon nursing facilities. A majority of individuals with DNR orders requested some other form of life-extending treatment, and advanced age was associated with orders to limit treatments.
AB - OBJECTIVES: Program was designed to communicate resident/surrogate treatment preferences in the form of medical orders. To assess statewide nursing facility use of the Physician Orders for Life-Sustaining Treatment (POLST) and to identify the patterns of orders documented on residents' POLST forms. DESIGN: Telephone survey; on-site POLST form review. SETTING: Oregon nursing facilities. PARTICIPANTS: One hundred forty-six nursing facilities in the telephone survey; 356 nursing facility residents aged 65 and older at seven nursing facilities in the POLST form review. MEASUREMENTS: A telephone survey; onsite POLST form reviews. RESULTS: In the telephone survey, 71% of facilities reported using the POLST program for at least half of their residents. In the POLST form review, do-not-resuscitate (DNR) orders were present on 88% of POLST forms. On forms indicating DNR, 77% reflected preferences for more than the lowest level of treatment in at least one other category. On POLST forms indicating orders to resuscitate, 47% reflected preferences for less than the highest level of treatment in at least one other category. The oldest old (≥85, n = 167) were more likely than the young old (65-74, n = 48) to have orders to limit resuscitation, medical treatment, and artificial nutrition and hydration. CONCLUSION: The POLST program is widely used in Oregon nursing facilities. A majority of individuals with DNR orders requested some other form of life-extending treatment, and advanced age was associated with orders to limit treatments.
KW - Elderly
KW - End-of-life treatments
KW - Ethics
KW - Nursing facilities
KW - Out-of-hospital DNR
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U2 - 10.1111/j.1532-5415.2004.52402.x
DO - 10.1111/j.1532-5415.2004.52402.x
M3 - Review article
C2 - 15341541
AN - SCOPUS:4444268510
SN - 0002-8614
VL - 52
SP - 1424
EP - 1429
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 9
ER -