fundamentals
Do Not Resuscitate (DNR) Orders
Portable Medical Orders
Portable medical orders communicate end-of-life care decisions of people with Hospice Care . In the United States, portable medical order programs are implemented at the state level and are most commonly called Provider Orders for Life-Sustaining Treatment or 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). These programs involve a professional-initiated discussion and shared decision-making process with people with advanced or end-stage illness. It results in a portable set of medical orders, consistent with the person’s goals of care, addressing the person’s wishes in regards to the use of CPR, the overall level of medical intervention wanted (for example, full treatment, comfort care only, or some intermediate level), and whether to seek or avoid hospitalization. Most portable medical order programs also address artificial nutrition and hydration. Some states address additional considerations, such as use of a ventilator or antibiotics that potentially could be used in a medical crisis. These programs are applicable across all care settings. In a medical crisis, emergency medical technicians and other health care professionals should first follow POLST or other similar orders. If immediate action is not essential, these orders should be reviewed with the person whenever the person's condition changes significantly, the person's venue of care changes, or the person chooses to change his or her wishes. For people lacking decision-making capacity, their authorized surrogates can act on their behalf. A portable medical order like POLST differs from advance directives in that it applies only to people with advanced illness, it provides a treatment plan in the form of medical orders for emergency decisions, and it is focused on the person’s current condition, not a future hypothetical condition. POLST or similar programs exist in every state and a national POLST organization provides a clearinghouse atwww.polst.org. 