special subjects
Do Not Resuscitate (DNR) Orders and Portable Medical Orders
Portable Medical Orders
Portable medical orders communicate end-of-life care decisions of people with advanced illness. In the United States, portal medical order programs are implemented at the state level and are commonly called Provider Orders for Life-Sustaining Treatment (POLST). Other names for such programs include Medical Orders for Life-Sustaining Treatment (MOLST), Physician Orders for Scope of Treatment (POST), Medical Orders for Scope of Treatment (MOST), Clinical Orders for Life-Sustaining Treatment (COLST), and Transportable Physician Orders for Patient Preferences (TPOPP). The programs follow a common paradigm but have somewhat different forms and policies. The most common criterion for qualifying as advanced illness in these programs is if the clinician would not be surprised if the patient were to die within the next year or two. In every state, the process is initiated by health care professionals through discussions with the patient or surrogate about the patient’s current condition and goals of care. It results in a set of medical orders that is portable across all health care settings and addresses CPR, along with overall goals of treatment (eg, comfort care only, full curative treatments, or limited treatments in between) and usually other critical care decisions, such as the use of artificial nutrition and hydration. These programs can help clinicians best honor their patients' wishes regarding goals of treatment and help ensure continuity across care settings. POLST or similar programs exist in every state, and a national POLST organization provides a clearinghouse atwww.polst.org. 