Communications during Life Limiting Illness & POLST in SC

Walter Limehouse, MD, MA

MUSC Ethics Comte

Objectives

Identify SC Coalition for Care of Serious Illness (SCC-CSI)

Outline MUSC clinical policy C-169 Describe POLST in SC: POST

Serious Illness Communications

SCMA & SCHA –revisit “medical futility” concern (2010) SCMA annual meeting resolution, May 2010:

STANDARD COMMUNICATION, CONSENT AND DECISION-MAKING PROCESS FOR SERIOUSLY ILL INPATIENTS IN SOUTH CAROLINA

Serious Illness Communications

SCMA House of Delegates, May 2010 Determine decision-making capacity

according South Carolina law; Determine decision makers or surrogates; Determine patients’ understanding, beliefs,

values, and wishes; Facilitate effective communication; and Call palliative care and/or ethics consults to

address concerns.

SC Coalition for Care of Serious Illness (SCC-CSI) Charter groups represent diverse state-

wide interests SC Medical Association SC Nurses Association SC Hospital Association SC Healthcare Ethics Network Carolinas Center for Hospice & End-of-Life Care SC Society of Chaplains, LifePoint, AARP

SCC-CSI Vision Statement

SC delivers excellent communication and shared decision-making for persons with serious, chronic, or terminal illnesses

SCC-CSI Initiatives @ MUSC

Improving communications clinical policy C-169

Communication Process for Inpatients with Life Limiting Illness

POLST Physician Orders of Life Sustaining Treatment

POST in SC Physician

Orders on Scope of Treatment

MUSC Clinical Policy C-169

Communication Process for Inpatients with Life Limiting Illness

Life-limiting illness triggers for communications process Terminal illness with projected death

within 6 months Chronic debilitating illness with

readmissions and/or multiple ED visits Major events, like stroke, resulting in

direct ICU admission or transfer Other illnesses, as so determined by the

attending physician

Process Facilitator

Nurse case manager or social worker as shepherd facilitates completion of process forms with

medical team schedules meetings as needed to develop or

revise goals of treatment may document meeting discussions and

attendance.

Process follows SCMA resolution

Determine decision-making capacity Determine decision-makers or surrogates Determine patients’ understanding, beliefs,

values, and wishes Facilitate effective communication and

shared decision-making for time interval Call palliative care and/or ethics consults

to address concerns

Forms

Serious Illness Planning Progress Note https://www.musc.edu/cce/ORDFRMS/pdf/all_all_docu_seriousillnesspl

anningprognote.pdf

Serious Illness Continuing Care Planning Progress Note

POLST paradigm Physician Orders on Life Sustaining Treatment

Physician orders scope of resuscitative treatment during life

threatening emergency Advance planning with patients

patient death not unexpected within 1 year Personal physician revises form with patient

upon change of patient condition or choices annually

POLST paradigm Physician Orders on Life Sustaining Treatment Orders cross institutional boundaries

home, assisted living, skilled nursing facility EMS pre-hospital Hospital

emergency department & inpatient POLST in Action in Oregon (video)

http://www.youtube.com/watch?v=CtrrnAJfT2s&context=C3f17b7bADOEgsToPDskJZLOgVI-NCrNBJSeCyi--I

Oregon POLST Form & Process

-1991 -Bright Pink -Legally binding for EMS -Valid across institutional boundaries

SC EMS DNR Form & Process

-Physician order -Legally binding for EMS -Valid only pre-hospital

Developing ProgramsDeveloping Programs

National POLST Paradigm Programs

Endorsed ProgramsEndorsed Programs

No Program (Contacts)No Program (Contacts)*As of February 2012

POLST: POST in SC Physician Orders on Scope of Treatment

SCC-CSI organizational home for POST SC POST form - near ready for adoption. DHEC - ready to authorize POST pilots

Greenville & Charleston

MUSC Medical Executive Committee endorses CHARLESTON PILOT OF POST

collaborative initiative with MUSC & Roper

POLST: POST in SC Physician Orders on Scope of Treatment

SCMA annual meeting, April 2012 resolution endorsing POST being introduced

Questions: clinical policy C-169 or POST Please contact:

Walter Limehouse MD MA limehouw@musc.edu