Frequently Asked Questions for Health Care Professionals in Oregon
Who should have a POLST form?
Use of the POLST form is most appropriate for seriously ill persons with life-limiting or terminal illnesses. To determine whether a POLST 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 form is appropriate. It may also be appropriate for others who have strong personal beliefs about their health care preferences.
Who can complete a POLST form?
A health care professional such as a nurse, discharge
planner or social worker may 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, nurse practitioner (NP) or physician assistant (PA) to be valid. It is expected that the signer know that the orders are consistent with the patient's wishes (if knowable).
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Who can sign the Oregon POLST form?
A physician, nurse practitioner (NP) or physician assistant (PA) may sign the form.
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Is a stamped signature on the POLST form considered valid?
No. The form must have the original signature of the physician, nurse practitioner or physician assistant.
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Is a copy of the POLST form valid?
Yes.
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Is a faxed POLST form valid?
Yes.
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Is the patient signature required?
No. In the state of Oregon the patient signature or surrogate is optional.
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When should the POLST form be reviewed with the patient or surrogate?
The POLST form should be reviewed when a patient’s condition or wishes change and/or if the patient is transferred from one care facility to another.
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Does the POLST form expire?
No. The POLST form should be reviewed when a patient’s condition or wishes change or they are transferred from one care facility to another but it does not expire. Health care systems or facilities may establish guidelines for periodic review.
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What do you do if the patient does not have the ability to make his or her own medical decisions and the surrogate disagrees with the POLST form orders?
Having prior meaningful discussions between the patient (when they were still capable) and surrogate usually makes clear the wishes of the patient and avoids this infrequent situation. However when this does occur, the surrogate’s wishes should be respected. The goals of care can be explored further once the patient is stable and preferably with the patient’s health care professional that knows them well.
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How do I know if I have the correct surrogate?
At times the person claiming to be the patient’s surrogate is not the person with the authority to speak in the patient’s behalf. Oregon’s advance directive statute defines the surrogate in this priority: guardian, health care representative, spouse or partner of a registered civil union, majority of adult children, parent, majority of adult siblings, other relative or friend (ORS 127).
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What if the person with a POLST form can no longer communicate their wishes for care?
Family members may be able to speak on behalf of a loved one. A health care professional can complete the POLST form based on family members' understanding of their loved one’s wishes.
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Is an Oregon POLST form valid in other states, like Washington, Idaho or California?
Oregon was the first state to develop a POLST program and many other states are following this lead. Our bordering states have developing or well-developed programs. Patients, some of whom have POLST forms, living in communities close to state borders may have their care provided in the neighboring state. Generally, the POLST orders are followed and emergency medical services and hospitals should have policies that help first responders respect the patient’s wishes provided as orders on the form.
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Can hospitals accept POLST orders from physicians without admitting privileges?
Yes. The Oregon Medical Board issued an administrative rule in 2007 that addresses this issue as follows:
1) A physician or physician assistant licensed pursuant to ORS chapter 677 shall respect the patient’s wishes including life-sustaining treatments. Consistent with the requirements of ORS chapter 127, a physician or physician assistant shall respect and honor life-sustaining treatment orders executed by a physician, physician assistant or nurse practitioner. The fact that a physician, physician assistant or nurse practitioner who executed a life-sustaining treatment order does not have admitting privileges at a hospital or health care facility where the patient is being treated does not remove the obligation under this section to honor the order. In keeping with ORS chapter 127, a physician or physician assistant shall not be subject to criminal prosecution, civil liability or professional discipline.
(2) Should new information on the health of the patient become available the goals of treatment may change. Following discussion with the patient, or if incapable their surrogate, new orders regarding life-sustaining treatment should be written, dated and signed.
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Is a POLST form available in Spanish?
No, not as a medical order. A translated POLST form is available as a tool when speaking with the patient and medical interpreter. There is also a Spanish language version of the POLST brochure and an educational video in Spanish. Since the POLST form is read by emergency medical personnel, nurses, and doctors who may not speak Spanish so the signed medical orders must remain in English. Please contact the Center for Ethics in Health Care for more information about obtaining a translated version of POLST form contents.
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Can a POLST form be used for minors?
Yes. Thankfully, it is rare that a child develops a life-threatening illness. When this does occur, the POLST form can be used by the child’s health care professional to help emergency medical personnel, other members of the treatment team and even school officials know the goals of care and respect the parent’s wishes as the child’s health status declines.
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How can I order Oregon POLST forms?
Please click here to order forms online, or contact the Center for Ethics in Health Care at
503-494-3965.
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