Indiana Physician Orders for Scope of Treatment (IN POST)

Sonya M. Zeller, MBA, MSN, RN September 11, 2013

IN POST Form

• IN POST = Indiana’s Physician Orders for Scope of Treatment

• Law—July 1, 2013

• New advanced care planning

• End-of-life treatment preferences—last 12 months

• Patient/Surrogate and Physician signatures required—Official Physician Order

• Transfers across all settings

IN POST Form

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Source: www.in.gov/isdh/25880.htm

IN POST Form

• Standardized Order Form—found on the Indiana State Department of Health website at http://www.in.gov/isdh/25880.htm

• Purpose of IN POST Form…better identification and respect of patients’ preferences for treatment at end-of-life

• CPR-code or no code status

• Level of medical intervention– comfort measures stipulates no transfer to hospital for

life-sustaining treatment, transfer only if needs cannot be met at current location

– use of antibiotics (for comfort only or full treatment)– use of medically administered nutrition

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IN POST Form Criteria

• Criteria for IN POST Form: must have one or more of the following conditions:– Advanced chronic progressive illness– Advanced chronic progressive frailty

• Note: Frailty is a medical diagnosis – A terminal condition– Unlikely to benefit from CPR

• Question to ask: Would the patient’s physician be surprised if the patient died within the next 12 months?

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IN POST Form Conversations

• IN POST Form can be filled out based on a conversation regarding patient end-of-life care preferences

• Surrogate decisions must be based on prior known wishes or best interest of patient

• Conversation regarding the IN POST Form can be initiated by anyone

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Types of Advance Directives in IN

• Talking directly with physician and family

• Organ and tissue donation

• Health care representative

• Living Will Declaration or Life-Prolonging Procedures Declaration

• Psychiatric advance directives

• Out of Hospital Do Not Resuscitate Declaration and Order

• Physician Orders for Scope of Treatment (POST) Source: www.in.gov/isdh/files/advanceddirectives.pdf

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IN POST Legal Protection

• The IN POST Act provides legal protection for health care providers who comply with the orders on IN POST forms

• In the law, health care providers are not subject to civil or criminal liability for good faith compliance with or reliance upon IN POST Forms

Source: www.iupui.edu/~irespect/POST.html

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POLST and IN POST

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• Dark pink = endorsed

• Light pink = developing

• White = no activitySource: www.polst.org

IN POST Evidence-Based

• POST supports patient-centered care by expanding beyond DNR/full code orders (Hammes et al., 2012; Hickman et al., 2004; 2009)

• POST is more effective than traditional approaches at ensuring treatment preferences are documented as orders (Hickman et al., 2010);

• POST orders do change the kinds of treatments patients receive (Hickman et al., 2010);

• Treatments provided are largely consistent with POST orders (Hickman et al., 2011);

• POST is viewed as helpful by clinicians including EMTs and hospice personnel (Schmidt et al., 2004; Hickman et al., 2009)

Source: www.iupui.edu/~irespect/POST.html

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IN POST Supported

• Indiana Patient Preferences Coalition– Mission: To develop a standardized tool to record

patient wishes as medical orders that transfer across treatment settings with a goal of honoring individual preferences for care.

• A coalition of 60 + professionals in health care, ethics, law, and senior services committed to honoring patient treatment preferences

• First formed in August 2010 to explore the development of the Indiana version of the POLST Paradigm

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IN POST Legislative History

• 2012 Session - HB 1114 – Did not make it out of committee

• 2013 Session - HB 1182 – Passed Indiana House 99-0– Passed Indiana Senate 48-1 with amendments– Concurrence passed with vote of 95-0– Signed into law by Governor May 7, 2013 – Law Effective July 1, 2013

Source: www.iupui.edu/~irespect/POST.html

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IN POST Form and Conversation

• IN POST = Indiana’s Physician Orders for Scope of Treatment

• Law—July 1, 2013

• New advanced care planning

• End-of-life treatment preferences—last 12 months

• Patient/Surrogate and Physician signatures required—Official Physician Order

• Transfers across all settings

IN POST References

• Hickman, S. (2013). Overview of the Indiana POST. Retrieved from http://www.iupui.edu/~irespect/POST.html

• Indiana Department of Health. Advance Directives. (2013). Retrieved from http://www.in.gov/isdh/files/advanceddirectives.pdf

• Indiana University Purdue University Indianapolis. (2013). Retrieved from http://www.iupui.edu/~irespect/POST.html

• POLST. (2012). Retrieved from http://www.polst.org

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