Required Elements of a POLST Paradigm Program

1. Required Elements of a POLST Paradigm Program Bud Hammes, PhD Gundersen Lutheran Health System bjhammes@gundluth.org

2. Why core elements? A POLST Paradigm is a type of clinical intervention. Certain elements are essential in order for the system to be effectively replicated.

3. There are 9 required elements Form constitutes medical orders. Must be followed by health professionals who provide care across the continuum of care (Requires a signature of physician or other licensed HP and date/time.) Form is standardized in format, color, and wording.

4. …9 required elements (con’t) Form is primarily used with patients with advanced, progressive chronic illness, those for whom the “surprise” question answer is “no”, or those who wish to further define their preferences. Form may be used to limit treatment or to express the desire for full treatment

5. …9 required elements (con’t) Form provides clear direction about the desired response if the patient is pulseless and apneic. Form allows for clear directions about other life-sustaining treatment if the patient has serious cardiac or pulmonary problems and expresses instructions regarding the use of artificial nutrition and antibiotics

6. …9 required elements (con’t) Form transfers with the patient Health professionals are trained to use the form and to have discussion to complete the form. Measures are made to monitor the success of the program and its implementation

7. Optional Elements Signature of patient (or surrogate)* Reciprocity Surrogates can complete forms Some states also have DNR bracelets Section for basis of order Order signed by NP or PA Space to review document