PHYSICIAN ORDERS FOR SCOPE OF TREATMENT (POST) Misty Chicchirichi, RN, MSN, CHPN Clinical Manager...
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PHYSICIAN ORDERS FOR SCOPE OF TREATMENT (POST) Misty Chicchirichi, RN, MSN, CHPN Clinical Manager Blue Ridge Hospice based on a presentation by Laura Pole, RN, MSN, OCNS and Chris Pile, MD Virginia POST Collaborative and Palliative Care Partnership of the Roanoke Valley
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Transcript of PHYSICIAN ORDERS FOR SCOPE OF TREATMENT (POST) Misty Chicchirichi, RN, MSN, CHPN Clinical Manager...
PHYSICIAN ORDERS FOR SCOPE OF TREATMENT
(POST)
Misty Chicchirichi, RN, MSN, CHPNClinical ManagerBlue Ridge Hospice
based on a presentation byLaura Pole, RN, MSN, OCNS and Chris Pile, MDVirginia POST Collaborative andPalliative Care Partnership of the Roanoke Valley
CONVERSATIONS THAT CHANGE OVER TIME
Healthy adults: emergency planning
People with progressive illness: guided planning
End stage illness: Physician Orders for Scope of Treatment
ONE CONVERSATION CAN MAKE ALL THE DIFFERENCE
60% of people say that making sure their family is not burdened by tough decisions is “extremely important”
56% have not communicated their end of life wishes
70% say they prefer to die at home
7% report having had an end of life conversation with their doctor
82% say it’s important to put their wishes in writing
23% have actually done it
www.theconversationproject.org
DIFFERENCES BETWEEN POST AND ADVANCE DIRECTIVES
Characteristics POST Advance Directives
Population For the seriously ill All adults
Timeframe Current care Future care
Who completes the form
Health Care Professionals
Patients
Resulting form Medical Orders (POST) Advance Directives
Health Care Agent or Surrogate role
Can engage in discussion if patient lacks capacity
Cannot complete
Portability Provider responsibility Patient/family responsibility
Periodic review Provider responsibility Patient/family responsibility
Bomba PA, Black J. The POLST: An improvement over traditional advance directives. Cleveland Clinic Journal of Medicine. July 2012; V 79, No.7: 457-464.
1900 2008
Average age of death 47 years of age 78 years of age
Causes of death Infection (34%)
Heart disease (25%)
Heart disease (9%) Cancer (23%)
CVA (7%) COPD (6%)
Accidents (5%)
CVA (5%)
Time of disability before death
Days, weeks 2 years
CENTURY OF CHANGE
RESEARCH FINDINGS
THE CARE PLANNING ACT OF 2013
WHAT IS POST? POST: Physician Orders for Scope of Treatment
All are derived from the POLST movement, which “…began in Oregon in the early 1990s to overcome the limitations of CPR Orders” (Hickman, et al. 2009)
HISTORY OF POST IN VIRGINIA
HISTORY OF POST IN VIRGINIA CONTINUED…
EXAMPLES OF POLST PROGRAMS
POLSTPhysician Orders for Life-Sustaining Treatment
POSTPhysician Orders for Scope of Treatment
MOLSTMedical Orders for Life-Sustaining Treatment
MOSTMedical Orders for Scope
of Treatment
OregonCaliforniaGeorgia
VirginiaWest Virginia
Idaho
New YorkMassachusett
sMaryland
ColoradoNorth
Carolina
Virginia POST Collaborative As of March 2014
Virginia POST Collaborative As of March 2015
POST IS DESIGNED TO HONOR THE FREEDOM OF PERSONS WITH ADVANCED
ILLNESS OR FRAILTY TO HAVE OR TO LIMIT TREATMENT
ACROSS SETTINGS OF CARE
WHEN IS THE RIGHT TIME FOR POST?
The “Surprise” questionWould you be surprised if this person died in the next year? If the answer is “no” (you wouldn’t be surprised), then a POST form may be the best documentation of the patient’s informed for medical treatment
WHY POST?
“…clinical experience and research demonstrate that these advanced directives are not sufficient alone to assure that those who suffer from serious, advanced, progressive chronic illnesses will have their preferences for treatment honored unless a POST form is also completed…”
http://www.polst.org/about-the-national-polst-paradigm/what-is-polst/ May 16,2014
WHY POST WORKS…
Transfers across care settingsContains specificsIt IS a physician’s order-no interpretation is needed and POST orders are to be followedClear, specific language on an actionable formBright colored form easily found among paperworkOrders honored throughout the system
ENDORSEMENTS
POST provides a better means than AD alone to identify and respect patients’ wishes
POST completion will improve end-of-life care throughout the system
Use of POST requires communication to make it work in your community
Local, Regional and Statewide collaboration is pivotal to making POST available as a uniform, portable and legal document and process
In Conclusion…
RESOURCES
The Conversation Project www.theconversationproject.org
Respecting Choices www.respectingchoices.org
National POST Paradigm www.polst.org
Virginia POST collaborative www.virginiapost.org
“Hard Choices for Loving People” by Hank Dunn
Caring Connections (National Hospice and Palliative Care Organization) – http://www.caringinfo.org
