Indiana Physician Orders for Scope of Treatment (IN POST) Sonya M. Zeller, MBA, MSN, RN September 11, 2013

IN POST Form IN POST = Indiana’s Physician Orders for Scope of Treatment Law—July 1, 2013 New advanced care planning End-of-life treatment preferences—last 12 months Patient/Surrogate and Physician signatures required—Official Physician Order Transfers across all settings

IN POST Form 10/18/20153 Source:

IN POST Form Standardized Order Form—found on the Indiana State Department of Health website at Purpose of IN POST Form…better identification and respect of patients’ preferences for treatment at end-of-life CPR-code or no code status Level of medical intervention –comfort measures stipulates no transfer to hospital for life-sustaining treatment, transfer only if needs cannot be met at current location –use of antibiotics (for comfort only or full treatment) –use of medically administered nutrition 10/18/20154

IN POST Form Criteria Criteria for IN POST Form: must have one or more of the following conditions: –Advanced chronic progressive illness –Advanced chronic progressive frailty Note: Frailty is a medical diagnosis –A terminal condition –Unlikely to benefit from CPR Question to ask: Would the patient’s physician be surprised if the patient died within the next 12 months? 10/18/20155

IN POST Form Conversations IN POST Form can be filled out based on a conversation regarding patient end-of-life care preferences Surrogate decisions must be based on prior known wishes or best interest of patient Conversation regarding the IN POST Form can be initiated by anyone 10/18/20156

Types of Advance Directives in IN Talking directly with physician and family Organ and tissue donation Health care representative Living Will Declaration or Life-Prolonging Procedures Declaration Psychiatric advance directives Out of Hospital Do Not Resuscitate Declaration and Order Physician Orders for Scope of Treatment (POST) Source: 10/18/20157

IN POST Legal Protection The IN POST Act provides legal protection for health care providers who comply with the orders on IN POST forms In the law, health care providers are not subject to civil or criminal liability for good faith compliance with or reliance upon IN POST Forms Source: 10/18/20158

POLST and IN POST 10/18/20159 Dark pink = endorsed Light pink = developing White = no activity Source:

IN POST Evidence-Based POST supports patient-centered care by expanding beyond DNR/full code orders (Hammes et al., 2012; Hickman et al., 2004; 2009) POST is more effective than traditional approaches at ensuring treatment preferences are documented as orders (Hickman et al., 2010); POST orders do change the kinds of treatments patients receive (Hickman et al., 2010); Treatments provided are largely consistent with POST orders (Hickman et al., 2011); POST is viewed as helpful by clinicians including EMTs and hospice personnel (Schmidt et al., 2004; Hickman et al., 2009) Source: 10/18/201510

IN POST Supported Indiana Patient Preferences Coalition –Mission: To develop a standardized tool to record patient wishes as medical orders that transfer across treatment settings with a goal of honoring individual preferences for care. A coalition of 60 + professionals in health care, ethics, law, and senior services committed to honoring patient treatment preferences First formed in August 2010 to explore the development of the Indiana version of the POLST Paradigm 10/18/201511

IN POST Legislative History 2012 Session - HB 1114 –Did not make it out of committee 2013 Session - HB 1182 –Passed Indiana House 99-0 –Passed Indiana Senate 48-1 with amendments –Concurrence passed with vote of 95-0 –Signed into law by Governor May 7, 2013 –Law Effective July 1, 2013 Source: 10/18/201512

IN POST Form and Conversation IN POST = Indiana’s Physician Orders for Scope of Treatment Law—July 1, 2013 New advanced care planning End-of-life treatment preferences—last 12 months Patient/Surrogate and Physician signatures required—Official Physician Order Transfers across all settings

IN POST References Hickman, S. (2013). Overview of the Indiana POST. Retrieved from Indiana Department of Health. Advance Directives. (2013). Retrieved from Indiana University Purdue University Indianapolis. (2013). Retrieved from POLST. (2012). Retrieved from 10/18/201514