Frequently Asked Questions
What does "POLST Paradigm" mean?POLST stands for Physician Orders for Life-Sustaining Treatment. We use the term "POLST Paradigm" to describe several programs, developed on a state or community-wide basis, having different program names, forms, and policies. What is a POLST Paradigm Program?A Physician Orders for Life-Sustaining Treatment (POLST) Paradigm Program is designed to improve the quality of care people receive at the end of life by turning patient goals and preferences for care into medical orders. POLST is based on communication between the patient or other legally designated medical decision-maker and health care professionals that ensures that patients understand the decisions they are making. The POLST Paradigm Program:
What is a POLST Paradigm form?A POLST Paradigm form is a brightly colored, medical order form, used to write orders indicating life-sustaining treatment wishes for seriously ill patients. The form accomplishes two major purposes:
Who should have a POLST Paradigm form?Use of the POLST Paradigm form is most appropriate for seriously ill persons with life-limiting or terminal illnesses. To determine whether a POLST Paradigm form should be encouraged, clinicians should ask themselves, "Would I be surprised if this person died in the next year?" If the answer is "No, I would not be surprised", then a POLST Paradigm form is appropriate. Remember that a POLST Paradigm form is designed to express the individual's preferences for levels of treatment and can indicate either full treatment including resuscitation attempts or can be used to limit those interventions that are not desired by the individual. Unless it is the patient's preference, use of the POLST Paradigm form to limit treatment is not appropriate for persons with stable medical or functionally disabling problems who have many years of life expectancy. In the absence of a POLST Paradigm form or other state-specific do-not-resuscitate orders, patients will receive advanced cardiac life support, including CPR, endotracheal intubation, and defibrillation, by emergency medical personnel based on standard protocols. How is the form used?In a health care facility, the form should be the first document in the clinical record. It should be recognized as a set of medical orders, to be implemented with the same procedure as all medical orders. In a non-institutionalized setting (such as a home), the form should be placed in a location recognized by emergency medical personnel, usually on the side or front of refrigerator. How is the form transferred from one setting to another?The original form must be transferred with the individual. A health care facility should keep a duplicated copy in the permanent medical record upon discharge. Who completes and signs a POLST Paradigm form?A health care professional or social worker must complete the form after discussion with the patient or surrogate that takes into account the goals of care. The form must be signed by a physician, and in some states it may be signed by a nurse practitioner (NP) or physician assistant (PA), to be valid. It is recommended that the signing physician know that the orders are consistent with the patient's wishes (if knowable). Is the date and contact information for the signing physician required?Yes. It is required that all POLST Paradigm forms have the signature date and contact information for the signing physician (NP or PA). Does a POLST Paradigm form replace traditional Advance Directives?No. Traditional Advance Directives are recommended for all adults to appoint a surrogate and express values. When available, an Advance Directive should accompany a POLST Paradigm form as it helps identify surrogate and may identify values but is not required for the orders to be valid. Is the patient or surrogate's signature required?Requirement of the patient or surrogate signature differs for each POLST Paradigm Program. The National POLST Paradigm Initiative Task Force strongly recommends the requirement of a patient or surrogate signature. Do any POLST Paradigm Programs require POLST by law?No. The POLST Paradigm form is always voluntary and is intended to:
Can completion of the POLST Paradigm form be mandated to better understand patient wishes?No. Use of the POLST Paradigm form is always voluntary. Can a POLST Paradigm form be used for minors?Some programs allow the form to be used for minors who have advanced serious or terminal illness. These programs have worked closely with health care systems, EMS, the school system, and state agencies to protect minors and honor their wishes for treatment. Generally, the parents are entrusted by law as the surrogate. Can a POLST Paradigm form be used for persons with significant physical disabilities, developmental disabilities, and/or severe persistent mental illness?Use of the POLST Paradigm form is most appropriate for seriously ill persons with life-limiting or terminal illness. To determine whether a POLST Paradigm form should be encouraged, clinicians should ask themselves, "Would I be surprised if this person died in the next year?" If the answer is "No, I would not be surprised", then a POLST Paradigm form is appropriate. Use of the POLST Paradigm form to limit treatment is not appropriate for persons with stable medical or functionally disabling problems who have many years of life expectancy. In the absence of a POLST Paradigm form or other state-specific do-not-resuscitate orders, patients will receive advanced cardiac life support, including CPR, endotracheal intubation, and defibrillation, by emergency medical personnel based on standard protocols. My state doesn't have a POLST Paradigm Program; can my organization still use a form?No. A POLST Paradigm Program requires collaboration and involvement from health care, ethics and legal professionals, hospitals, long term care, hospice, and emergency medical services. Please see Developing a Program for more information about this process. Why are some states on the national map "light pink"?Developing POLST Paradigm Programs are recognized on the national map by being colored "light pink". This includes statewide programs and community-based programs. Programs must complete and submit the POLST Paradigm Program Information form to the National POLST Paradigm Initiative Task Force to be considered developing. Why are some states on the national map "dark pink"?Endorsed POLST Paradigm Programs are recognized on the national map by being colored "dark pink". To be considered for endorsement by the National POLST Paradigm Initiative Task Force simply complete two items: the Program Requirement Checklist and the POLST Paradigm Program Endorsement form. Within six weeks the Task Force will review your information, endorse your program if criteria are met and provide feedback about your program. Consider these additional questions:
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