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Provider Orders for Life-sustaining Treatment (POLST) is a set of portable medical orders that communicate patient wishes for end-of-life intervention to health care facilities and providers, including Emergency Medical Services (EMS). A POLST initiative seeks to use one style of form applicable across all health care settings, signed by a patient, or their surrogate, and their health care provider.
Over the past three decades, health care providers, patients and families recognized the growing need for informed conversations and communication tools to help patients define their end-of-life care decisions and advanced directives.
To address this issue, an Oregon task force developed the first POLST form in 1995. Since then, a majority of states have adopted similar standardized programs and forms. The American Association of Nurse Practitioners® (AANP) uses POLST as the association’s standard terminology, although these initiatives may be referred to in a state by a similar variation:
The goal of POLST is to ensure that patient wishes are known and honored by health care providers, including EMS personnel.
POLST is a complement to, but does not replace, advanced directives. POLST provides additional specificity about the types of treatments and interventions a patient with serious, life-limiting or terminal illness wishes to receive or avoid. The form requires signature of both the health care provider and the patient (or their surrogate) to be a valid portable medical order.
The following forty states and Washington D.C. have codified thier POLST programs into law or an official form:
Alaska, Arkansas, California, Colorado, Connecticut, District of Columbia, Delaware, Georgia, Hawaii, Idaho, Illinois, Indiana, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Vermont, Washington, West Virginia and Wyoming.
Nurse practitioners (NPs) are authorized to sign a POLST form in the following 34 states and Washington D.C.:
Alaska, California, Colorado, Connecticut, District of Columbia, Delaware, Hawaii, Idaho, Illinois, Indiana, Iowa, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nevada, New Hampshire, New Jersey, New York, North Carolina, North Dakota, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Utah, Virginia, Vermont, Washington, West Virginia and Wyoming.
In addition to honoring a patient’s wishes for their course of treatment, these modernized POLST programs ensure continuity of care by honoring the patient’s choice of clinician.
A few states have yet to establish an official single POLST form authorized by regulation or statute. However, these states may address elements of advanced directive and end-of-life care planning through other forms, programs and policies.
As part of an advanced directive planning process, POLST and similar programs help patients and their families make their preferences for end-of-life care and treatment interventions known. Care transitions and hand-offs between facilities are simplified and standardized with portable orders, allowing families and clinicians to prioritize the patient over paperwork.
Completing a POLST form is completely voluntary, yet increasingly considered part of routine care. It is incumbent upon NPs to be familiar with POLST forms and state or jurisdiction requirements. Because some state laws still vary in recognition of NP signatures on POLST forms, policy changes to existing and developing POLST programs continue to be necessary.
AANP encourages NPs to be prepared to discuss advanced care planning with patients who may be candidates for POLST and to verify that a patient’s end-of-life forms are valid with an NP signature.
If POLST or other advanced directive legislation is proposed in your state, please contact the AANP State Government Affairs office at 703-740-2529 or email@example.com. AANP welcomes the opportunity to work with state stakeholders to shape legislation that is beneficial and appropriate for patients, NPs and the entire health care community.
© American Association of Nurse Practitioners, Revised November 2019