Massachusetts Massachusetts

Medical Orders for Medical Orders for

Life-Sustaining Life-Sustaining

TreatmentTreatment

MOLST in Massachusetts: Overview and Expansion UpdateFollowing the Patient in the Healthcare Journey

MOLST Implementation STAAR/MassPRO ConferenceChristine McCluskey, RN, MPHDirector for MOLST Expansion

October 30, 2012

The Massachusetts MOLST project is a collaboration of the:

• Massachusetts Department of Public Health

• Massachusetts Executive Office of Elder Affairs and

• Commonwealth Medicine at UMass Medical School

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Objectives

• Describe MOLST and its place along the advance care planning continuum

• Name steps involved in MA MOLST implementation in health care facilities

• List resources for learning more about Medical Orders for Life-Sustaining Treatment

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MOLST is… A standardized hot pink-colored form* that contains a patient’s

preferences about life-sustaining medical treatments.

Valid medical orders that can be honored across all health care settings.

A clinical standard of practice for documenting and communicating patient preferences about life-sustaining medical treatments.

A dynamic form, meant to be updated along with changes in a patient’s health status or treatment preferences.

* Original MOLST forms are created on hot pink-colored paper to maximize visibility and portability. Electronic, faxed and non-pink forms are also valid.

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MOLST in the Advance Care Planning Continuum

Fill out health care proxy form to appoint Health Care Agent

Fill out a MOLST Form

Everyone age 18 and older

End-of-Life Preferences Communicated and Honored

Only if diagnosed with an advanced Illness (any age)

Review/update proxy form periodically

CC OO NN VV EE RR SS AA TT II OO NN SS

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Which patients are suitable for MOLST?

Patients of any age with an advanced illness including, but not limited to:

– Life-threatening diseases

– Chronic progressive diseases

– Life-threatening injuries

– Medical frailty

– Any patient suitable for considering DNR orders

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MOLST Takeaway Messages

• MOLST is not an advance directive.

• MOLST is a medical form containing medical orders created by clinicians, based on a patient’s current health condition and effective immediately when signed.

• All adults aged 18 and older should still complete a health care proxy form to appoint a health care agent to make decisions for them in the event of loss of capacity.

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MOLST Expansion in Massachusetts

2008 – 2009 Acts of 2008 mandate and

Planning for “POLST” pilot project

Goal: 2014

Statewide MOLST

use

20102011-12

Spring 2012

June 2012

2012-13

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To launch MOLST in Clinical Care Institutions:

1. Review MOLST information and resources at www.molst-ma.org.

2. Identify a “MOLST Clinical Champion” within the institution.

3. Access the MOLST Implementation Tool Kit at: www.molst-ma.org.

4. Begin the self-paced MOLST implementation process.

5. Set or estimate a MOLST launch date and access MOLST forms on line at www.molst-ma.org.

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Visit the Massachusetts MOLST Website for:

• More information about MOLST

• Answers to Frequently Asked Questions

• MOLST training materials for health professionals

• Registration for conference calls and events

• Patient and family information and materials

• Informative video about MOLST in Massachusetts

www.molst-ma.org

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MOLST Website: molst-ma.org

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MOLST Video

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Self Directed Trainings

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Self Directed Trainings

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Other Resources

POLST website:http://www.ohsu.edu/polst/index.htm

MA End of Life Expert Panel: Final Report - Patient Centered Care and Human Mortalityhttp://www.mass.gov/hqcc/the-hcqcc-council/about-the-

hcqcc-council/meeting-schedule-and-materials/expert-

panel-on-end-of-life-care/

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