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Use of the POLST when transferring patients to a long term care facility. Bud Hammes, Ph.D. Gundersen Lutheran Medical Foundation. Need for out-of-hospital DNR orders. 1999 Medicare data shows that only 23% of deaths occurred in a hospital in the La Crosse area - PowerPoint PPT Presentation
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Use of the POLST when transferring patients to a long term care facility
Bud Hammes, Ph.D.Gundersen Lutheran Medical Foundation
Need for out-of-hospital DNR orders 1999 Medicare data shows that only
23% of deaths occurred in a hospital in the La Crosse area
Out of 540 deaths over 11 months the median age of death in La Crosse health organizations in 1996 was 82 years
Most deaths in La Crosse occur at home in hospice or in a nursing home
Out-of-Hospital DNR Protocols Emergency services and other
health professionals are expected to attempt CPR unless there is a DNR order!
CPR Outcomes In general pop. 2-15% survival at
discharge from hospital Long term care 0-5% survival at
discharge from hospital unwitnessed arrest 0% Long term survival 5% Public perception 45-85% success
Hx of area protocols Until 1997 out-of-hospital orders were
written on physician scripts or in facility order sheets.
In 1997 Wis Chapter 154.17 provided for a DNR bracelet.
1997 La Crosse area health organizations agree to use the POLST form to communicate orders to emergency services
Wisconsin DNR Bracelet
Advantages of POLST Available to all patients Is private Deals with a wide range of
emergency treatments Easy to maintain No discomfort to patient
Physician Orders for Life-Sustaining Treatment (POLST) (page 1)
Success of POLSTResearch in Oregon indicates that the
use of POLST is effective in limiting care according to preferences of nursing home residents.
Tolle SW et al. A prospective study of the efficacy of the physician order form for life-sustaining treatment. JAGS 46:1097-1102, 1998.
Eleven year comparison of CPR attempts at GLMC
Year # of attempts on pts 55 and >
# alive at discharge
% of survival at 1 year
1989 150 22 14.6%
2000 48 14 29%
Need for Improvement at GL Need to consider if a patient being
transferred to a nursing home for the first time wants CPR attempted in the case of cardiopulmonary arrest. One LTC facility had 16 new admissions
in one month from GL where no consideration of CPR status know upon admission.
Goals for all new transfers Help the patient or the patient’s surrogate
understand and reflect on the issues of CPR Include information of the conversation and
decision about CPR in the discharge summary.
Complete at least section A of the POLST for every patient who does not want CPR attempted in the case of a cardiopulmonary arrest.
