Considerations for Development or Revision of a POLST Paradigm Form

A major responsibility of a developing POLST Paradigm Program is to design a form that includes a medical order set.  Also, an established program must revise their form periodically to respond to advances in technology, considerations for special patient groups, and improved methods of communicating the orders.  The National POLST Paradigm Initiative Task Force has developed the following general and specific requirements to help guide programs in this responsibility.

General Requirements

• The treatment being considered requires a medical order that needs signature by a health care professional. 

• The medical order is based on medical indication and a person’s preferences for treatment (e.g. as expressed in an advance directive).

Specific Requirements

1. The treatment is a “comfort measure”; or
2. The order is an instruction regarding hospital transfer; or
3. The medical order is a life-sustaining treatment that is being considered for use in a person with advanced progressive illness and/or frailty and has these characteristics:
   • is frequently needed by health care professionals (e.g. EMS protocol, emergency department and ICU care, long-term care or hospice); and/or
   • is urgently needed by health care professionals (e.g. EMS protocol, emergency department and ICU care; long-term care or hospice); and/or
   • requires an informed consent process that is complex (e.g. tube feeding treatment); and/or
   • is not effectively specified as “Additional orders”.

back to top