The Oregon Portable Orders for Life-Sustaining Treatment (POLST) Program is designed to improve the quality of care people receive at the end of life. The program is based on effective communication of patient wishes, documentation of medical orders and a promise by a health care professional to honor these wishes.
Background of the program
In 1991, it was not uncommon for ill Oregonians nearing the end of life to receive unwanted medical treatment. To address this problem, The Center for Ethics convened a group of health care professionals including emergency medical services (EMS), medicine, nursing, hospice, and long-term care. Over a two-year period, the newly formed Task Force developed the Medical Treatment Coversheet (MTC); designed to help health care professionals honor the treatment preferences of their patients.
After initial evaluation and a name change to “Physician Orders for Life-Sustaining Treatment” (POLST) the form was released for use in Oregon in 1995. Using a “train-the-trainer” model, members of the task force initially educated health care professionals about use of the form. Ongoing education, research and a statewide experience-based continuous quality improvement process helped the task force improve the content of the POLST form and the process of implementation.
As Oregon’s program evolved, selected regulations rather than legislation were used to help with implementation. Other developing programs like West Virginia and New York sought legislation to facilitate POLST paradigm adoption. Each new program found that their approach needed to be thoughtfully tailored to state laws and regulations.