Contact Us | Home

SEARCH

GO

Find POLST Paradigm information and forms for:


Developing a Program

Program Requirements

A POLST Paradigm program must meet specific program requirements. These requirements are defined by members of the National POLST Paradigm Initiative Task Force who have experience and expertise in POLST Paradigm development.

Program Requirements

In order to be considered an endorsed POLST Paradigm Program, the Program must include these requirements:

  • The form constitutes a set of medical orders.
  • The form follows the considerations for development or revision of a POLST Paradigm form.
  • The process includes ongoing training of health care professionals across the continuum of care about the goals of the program as well as the creation and use of the form.
  • Use of the form is recommended for persons who have advanced chronic progressive illness, those who might die in the next year or anyone wishing to further define their preferences of care.
  • The National POLST Paradigm Initiative Task Force strongly recommends that all POLST Paradigm programs require the signature of either the patient or the patient’s legal representative to make the form valid, as allowed by statute and regulations. The signature of the patient (or the patient’s legal representative if the patient lacks decision-making capacity) provides evidence that patients or their legal representatives agree with the orders on the form. In this respect, the requirement that patients or their legal representatives review and sign the form provides a safeguard for patients that the orders on the form accurately convey their preferences. Completion of the POLST form is voluntary, and the goal of such a form is to ensure that the patient receives the level of care desired.
  • The form requires a valid Physician (Nurse Practitioner or Physician Assistant accepted depending upon program) signature and date of signature.
  • The form may be used either to clarify a request for all medically indicated treatments including resuscitation or to limit medical interventions.
  • The form provides explicit direction about resuscitation status if the patient is pulseless and apneic.
  • The form also includes directions about other types of intervention that the patient may or may not want. For example, decisions about transport, ICU care, antibiotics, artificial nutrition, etc.
  • The form accompanies the patient, and is transferable and applicable across care settings (i.e. home, long term care, hospice, EMS, hospital).
  • The form is uniquely identifiable, standardized, with a uniform color within a state/region.
  • There is a plan for ongoing evaluation of the program and its implementation.

Optional Elements

The following issues may be handled by programs in different ways depending on state law and local preferences.

  • Ideally, a legal surrogate should be able to make decisions about treatment choices for a patient without decision-making capacity, but states have varying laws regarding surrogates and decision making.
  • Some states may recognize the form as the only out-of-hospital DNR form; in others there may be other means of DNR ID as well. Use of the form is always voluntary.
  • Ideally, states would accept forms completed in other states (reciprocity).

back to top
"));