By Jennifer Cook, OPR Project Liaison
Understanding the goals of care with regards to end of life concerns are of critical importance when treating the patient who has a POLST form. Accessing POLST orders on scene is only the first step in the care process since what good are a set of orders if you don't know how to use them to treat the patient? The application of POLST orders on scene can be a big challenge since no two patients are truly alike. So how do you approach the patient who has a POLST?
On the newest revision of the Oregon POLST form you will find ‘Treatment Plan’ statements in bold that have been expanded to help us understand the intent behind the wording encountered in each of the section B paragraphs.
Let’s look at what each section means in terms of care goals according to the anticipated treatment plan.
- Comfort Measures Only, Treatment Plan: Maximize comfort through symptom management. This may seem obvious, but it's easy to get lost in various medical treatments without asking ourselves “is this a comfort care or not?” With regards to a proposed treatment, try to ask yourself which of the following best applies to the treatment you are considering:
1. “The primary goal in giving this treatment to make the patient more comfortable”
2. “The primary goal of this treatment to prolong their life”
If the answer is the first statement, you are on the right track, try it, and see what happens. If you apply the treatment and the patient is more comfortable, you have met the patient’s goal of care. And if it doesn’t work? Stop and try something else.
If the second statement applies then stop and reconsider. Look for another treatment where the primary goal is providing comfort not prolonging life. Of course, there are times when a comfort care may also prolong life; but that is ok, as long as prolonging life is a secondary effect and not the primary purpose of the treatment plan.
- Limited Additional interventions, Treatment Plan: Provide basic medical treatments.
What question might you ask in this case?
1. “Is this the simplest/most basic treatment solution that is likely to work?”
If the answer is “Yes” then go ahead and start the treatment. If you think, “no,” or “maybe not,” think through some other options, and see if they would be more applicable in this setting.
- Full Treatment, Treatment Plan: Full treatment, including life support measures as well as consideration of admission and care in the intensive care unit.
POLST does not mean “do not treat,” or “I want my care limited” - so don’t forget that POLST will also say, “Do everything medically feasible,” and when you see that statement, treat as per your standard of care for that particular condition.
And don’t forget to do a quick review of the POLST form on scene. Reviewing the choices a patient has made will help you if the stable patient suddenly deteriorates and also provides you with a sense of their goals with regards to end of life treatments.
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