The document discusses POLST (Physician Orders for Life-Sustaining Treatment), which is used to document patients' end-of-life treatment preferences. It outlines a series of questions asked of patients to determine their goals of care, including whether they would want CPR if their heart stopped or life-sustaining treatment if their lungs and heart could no longer provide oxygen to their organs. Answers to these questions determine the appropriate treatment options selected on the POLST form. The POLST is then signed by the patient and healthcare provider to document the patient's wishes.

1. POLST

2. Years – Months – Weeks – Days
Birth
Actively
Dying
Death
J Pain Symptom Manage. 2014 Jan; 47(1): 77–89.
Diagnosis
Treatment
New Problem

3. DNAR is a (Small) Part of Goals of Care
Birth
Actively
Dying (B)
Death (A)
(C)
www.polstil.org
Diagnosis
Treatment
New Problem

4. POLST
A. “If you had no heart beat and
are not breathing, that is you
are dead, what do you think
would be the best thing to
do? Try to bring you back,
which is a Full code, or
knowing that you have a
number of progressive health
conditions feel that a natural
death is right at that time,
which is Do Not Attempt
Resuscitation?”

5. POLST Continued
B. If they choose Full Code in A, then the only appropriate
selection in B is “Full Treatment”
If they chose DNAR, “If you are dying,
that is your lungs and heart cannot get
oxygen to your organs, what would like
us to do, take you to the hospital and
try to correct the situation, even using
life support (Full Treatment) or using
everything short of that (Selective
Treatment), or try to keep you
comfortable at home and only moving
you to keep you comfortable (Comfort-
Focused Care). No matter what you
chose if you are feeling ill you can
always elect to see your physician or
come to the hospital.”

6. POLST Continued
C. If they elected Comfort Care in B the only
appropriate selection is No medically
administered nutrition.
If they elected Selective
Treatment in B then any option
is appropriate.
If they elected Full Treatment
only Long-term or Trial period
of medical nutrition is
appropriate.
“Would you want artificial
nutrition, that is a tube in the
nose or in the belly that
supplies nutrition?”

7. POLST Continued
D. Make sure the patient or
surrogate and witness sign it.
E. Make sure that you sign
the POLST to complete it.
I make a copy to be
scanned in and return
the original to the
patient. I tell them to
place it on their fridge.