PHYSICIAN ORDERS FOR SCOPE OF TREATMENT (POST) Misty Chicchirichi, RN, MSN, CHPN Clinical Manager Blue Ridge Hospice based on a presentation by Laura Pole, RN, MSN, OCNS and Chris Pile, MD Virginia POST Collaborative and Palliative Care Partnership of the Roanoke Valley

CONVERSATIONS THAT CHANGE OVER TIME Healthy adults: emergency planning People with progressive illness: guided planning End stage illness: Physician Orders for Scope of Treatment

ONE CONVERSATION CAN MAKE ALL THE DIFFERENCE 60% of people say that making sure their family is not burdened by tough decisions is “extremely important” 56% have not communicated their end of life wishes 70% say they prefer to die at home 7% report having had an end of life conversation with their doctor 82% say it’s important to put their wishes in writing 23% have actually done it

DIFFERENCES BETWEEN POST AND ADVANCE DIRECTIVES CharacteristicsPOSTAdvance Directives PopulationFor the seriously illAll adults TimeframeCurrent careFuture care Who completes the formHealth Care ProfessionalsPatients Resulting formMedical Orders (POST)Advance Directives Health Care Agent or Surrogate role Can engage in discussion if patient lacks capacity Cannot complete PortabilityProvider responsibilityPatient/family responsibility Periodic reviewProvider responsibilityPatient/family responsibility Bomba PA, Black J. The POLST: An improvement over traditional advance directives. Cleveland Clinic Journal of Medicine. July 2012; V 79, No.7:

Average age of death47 years of age78 years of age Causes of deathInfection (34%)Heart disease (25%) Heart disease (9%)Cancer (23%) CVA (7%)COPD (6%) Accidents (5%)CVA (5%) Time of disability before deathDays, weeks2 years CENTURY OF CHANGE

RESEARCH FINDINGS

THE CARE PLANNING ACT OF 2013

WHAT IS POST?  POST: Physician Orders for Scope of Treatment  All are derived from the POLST movement, which “…began in Oregon in the early 1990s to overcome the limitations of CPR Orders” (Hickman, et al. 2009)

HISTORY OF POST IN VIRGINIA

HISTORY OF POST IN VIRGINIA CONTINUED…

EXAMPLES OF POLST PROGRAMS POLST Physician Orders for Life-Sustaining Treatment POST Physician Orders for Scope of Treatment MOLST Medical Orders for Life- Sustaining Treatment MOST Medical Orders for Scope of Treatment Oregon California Georgia Virginia West Virginia Idaho New York Massachusetts Maryland Colorado North Carolina

Virginia POST Collaborative As of March 2014

Virginia POST Collaborative As of March 2015

POST IS DESIGNED TO HONOR THE FREEDOM OF PERSONS WITH ADVANCED ILLNESS OR FRAILTY TO HAVE OR TO LIMIT TREATMENT ACROSS SETTINGS OF CARE

WHEN IS THE RIGHT TIME FOR POST? The “Surprise” question  Would you be surprised if this person died in the next year?  If the answer is “no” (you wouldn’t be surprised), then a POST form may be the best documentation of the patient’s informed for medical treatment

WHY POST? “…clinical experience and research demonstrate that these advanced directives are not sufficient alone to assure that those who suffer from serious, advanced, progressive chronic illnesses will have their preferences for treatment honored unless a POST form is also completed…” May 16,2014http://

WHY POST WORKS…  Transfers across care settings  Contains specifics  It IS a physician’s order-no interpretation is needed and POST orders are to be followed  Clear, specific language on an actionable form  Bright colored form easily found among paperwork  Orders honored throughout the system

ENDORSEMENTS

 POST provides a better means than AD alone to identify and respect patients’ wishes  POST completion will improve end-of-life care throughout the system  Use of POST requires communication to make it work in your community  Local, Regional and Statewide collaboration is pivotal to making POST available as a uniform, portable and legal document and process

RESOURCES The Conversation Project  Respecting Choices  National POST Paradigm  Virginia POST collaborative  “Hard Choices for Loving People” by Hank Dunn Caring Connections (National Hospice and Palliative Care Organization) –