1. POLST 2014: CA Updated Form Brandy Shannon, RN, MSN, DSD
Educator CCC and NCU
September 2014

2. Purpose
To educate the health care provider on the CA updated POLST Form for 2014.

3. Objectives Know the meaning of POLST and its indication.
Recognized the changes associated with the new CA POLST Form.
Be aware of the effective date of change and utilization of the new POLST Form.
Have a better understand of the POLST Form.

4. What is POLST?
Physician Orders for Life-Sustaining Treatment (POLST) is a form that gives seriously-ill patients more control over their end-of-life care, including medical treatment, extraordinary measures (such as a ventilator or feeding tube) and CPR.

5. What is PULST?
Printed on bright pink paper, and signed by both a doctor and patient, POLST can prevent unwanted or ineffective treatments, reduce patient and family suffering, and ensure that a patient's wishes are honored.

6. PULST Updates: Effective date
California’s revised Physician Orders for Life-Sustaining Treatment (POLST) form goes into effect on October 1,
Previous versions of POLST will still be honored after the form goes into effect, but all NEW POLST requests are to be completed on the undated October 1, form.

7. Key changes to POLST form:
In order to be consistent with Section A, treatment choices for Sections B and C have been switched in their order, and each section begins with the most aggressive and invasive treatment choices.

8. POLST Changes for 2014: NEW Form

9. POLST Form : 2011 Old Form

10. POLST Form Changes: Changes are indicated within the yellow boarders.
The wording has changed from the 2011 form to the 2014 form as indicated.
The Effective date has also changed.

11. POLST Form Changes:
In Section B, the choice of “Limited Additional Interventions” has been renamed to “Selective Treatment,” and the choice of “Comfort Measures Only” has been renamed to “Comfort- Focused Treatment.”
OLD POLST 2011
NEW POLST 2014

12. POLST Form Changes:
Goal statements have been added for each treatment choice in Section B. These descriptions help patients understand the goals of care within each option, and aim to promote quality conversations with a patient and/or legally recognized decision maker. The goal statements are as follows:
Full Treatment – primary goal of prolonging life by all medically effective means.
Selective Treatment – goal of treating medical conditions while avoiding burdensome measures.
Comfort-Focused Treatment – primary goal of maximizing comfort.

13. POLST Form Changes:
In Section B, the Full Treatment option features a box which can be marked to indicate: “Trial Period of Full Treatment.” This option is beneficial for patients who want to try short-term ventilatory support but do not want prolonged life support.

14. POLST Form Changes:
Section C: ARTIFICIALLY ADMINISTRED NUTRITION has been reversed.
OLD POLST 2011
NEW POLST 2014

15. POLST Form Changes:
Section D: Signature of Patient or Legally Recognized Decisionmaker, changes are noted.
Section D: Address and phone number changes noted.
Section D: New box noted. Office Use Only:
Section D: Bottom of the page has addition:
Form Versions with effective dates of 1/1/2009 or 4/1/2011 are also valid

16. POLST Form Changes:
Old POLST 2011
New POLST 2014

17. Reminder: POLST is a voluntary form.
Previously completed POLST forms remain valid.
It is recommended that POLST be copied on PINK PAPER to help ensure that the document stands out and is followed. However, POLST on any color paper is valid.
Copies and faxes of POLST are valid.
Whenever possible, ensure the Advance Directive and POLST form are consistent with each other.

18. Thank You: Please take Post-test