Premium
Use of the Physician Orders for Life‐Sustaining Treatment Program in Oregon Nursing Facilities: Beyond Resuscitation Status
Author(s) -
Hickman Susan E.,
Tolle Susan W.,
BrummelSmith Kenneth,
Carley Margaret Murphy
Publication year - 2004
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2004.52402.x
Subject(s) - medicine , resuscitation orders , nursing homes , telephone survey , do not resuscitate , nursing , family medicine , skilled nursing facility , advance care planning , do not resuscitate order , cardiopulmonary resuscitation , medical emergency , resuscitation , emergency medicine , palliative care , marketing , business
Objectives: Program was designed to communicate resident/surrogate treatment preferences in the form of medical orders. To assess statewide nursing facility use of the Physician Orders for Life‐Sustaining Treatment (POLST) and to identify the patterns of orders documented on residents' POLST forms. Design: Telephone survey; on‐site POLST form review. Setting: Oregon nursing facilities. Participants: One hundred forty‐six nursing facilities in the telephone survey; 356 nursing facility residents aged 65 and older at seven nursing facilities in the POLST form review. Measurements: A telephone survey; onsite POLST form reviews. Results: In the telephone survey, 71% of facilities reported using the POLST program for at least half of their residents. In the POLST form review, do‐not‐resuscitate (DNR) orders were present on 88% of POLST forms. On forms indicating DNR, 77% reflected preferences for more than the lowest level of treatment in at least one other category. On POLST forms indicating orders to resuscitate, 47% reflected preferences for less than the highest level of treatment in at least one other category. The oldest old (≥85, n=167) were more likely than the young old (65–74, n=48) to have orders to limit resuscitation, medical treatment, and artificial nutrition and hydration. Conclusion: The POLST program is widely used in Oregon nursing facilities. A majority of individuals with DNR orders requested some other form of life‐extending treatment, and advanced age was associated with orders to limit treatments.