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California Coalition for Culture Change
Issue: 40 October 30, 2009
Greetings!  
With Healthcare Decision Week coming up, Sam Ousey shares some up to date information and tips about POLST.  
RD News

Celebrate Health Care Decisions Week
  
This week, Oct- 23 thru the 31st Californians are encouraged to make decisions about their medical care before serious illness or injury occurs. Perhaps you have seen the pink POLST forms that have been slowly making their way in to Skilled Nursing Facilities? What does POLST have to do with healthcare decisions?
 
The Physician Orders for Life Sustaining Treatment (POLST) resulted from new California legislation enacted last year. POLST is a physician order that complements an Advanced Directive by converting an individual's wishes regarding life-sustaining treatment and resuscitation into a physician order. POLST was designed to be the portable physician order for end of life decisions which carries across treatment settings.  Residents and their families communicate their wishes about a full range of life sustaining and resuscitative measures with POLST. 
 
The POLST form:
POLST form*A standardized form (usually pink) and placed as the first page in the medical record
*If there are Advanced Directives they should be attached to the POLST form
*Can be revised or revoked by an individual with decision making capacity at any time
*Is legally sufficient and recognized as a physician order
*Is recognized across treatment setting
*Can be an alternative to"Do Not Resuscitate"
* May replace the "Preferred Intensity of Care"
 
The California Coalition for Compassionate Care web site provides a
free download of the form. Visit their sam walk for curewebsite for other references posted there, also.
 
The California Coalition for Compassionate Care has appointed a Task Force to implement and discuss POLST across medical settings. There are numerous medical associations involved in the review and implementation of POLST. CDA has appointed Sam Ousey, RD to this task force. As the only Registered Dietitian on this task force, Sam can contribute to the understanding of nutrition and hydration in end of life care.
RD Tip
Download a copy of POLST (click pink form above) and become familiar with the medical treatments, especially Nutrition /Hydration. Look for the Pink POLST Form in the resident's chart, paying attention to the Nutrition /Hydration preferences. Make sure you transfer the information to the Advanced Directive section on the Nutritional Assessment.  This information will be invaluable later to guide intervention decisions if the resident does not maintain acceptable parameters of nutrition. Be aware of POLST procedures in your assigned SNF. Discuss with nursing how you, as the RD, can assist families to make decisions about artificial nutrition treatments, including oral supplements, enteral feeding, IV nutrition and TPN.
Dear Dietitians;
 As an RD in long term care and a mother of young children, I have the perspective of seeing the continuum of life from young to old. While we accept death as a part of this journey, as dietitians we are nurturers who want to sustain a quality of life for the residents to the very end. As I participate in discussions with other healthcare professionals, it has helped me to understand better the end of life care decisions. Discussion is healthy and helps us adapt to change and grow. I am honored to represent the dietetics profession on the CCCC task force. If you have suggestions for the task force please send them to me.
 
Since many of us have aging family members ourselves, I encourage you to consider the value of an Advanced Directive, or even POLST, for yourself and your family members.  
                               
Sam OuseySam Ousey, RD
Vice President
HMComposite, Inc.