Physician Orders for Life-Sustaining Treatment (POLST) is a medical order that outlines a plan of care reflecting a patient’s wishes concerning care at life’s end. The POLST form is voluntary and is intended to:
- Help you and your patient discuss and develop plans to reflect his or her wishes
- Assist physicians, nurses, healthcare facilities, and emergency personnel in honoring a person’s wishes for life-sustaining treatment
Having a conversation with a seriously-ill patient about end-of-life issues is an important and necessary part of good medical care. POLST can provide structure for those important discussions between you and your seriously-ill patients.POLST is making a difference. Studies have shown that among patients with POLST forms treatment preferences were respected 98% of the time, and no one received unwanted CPR, intubations, intensive care or feeding tubes.
At the Coalition for Compassionate Care of California (CCCC), we are here to help guide you through the use of POLST. We offer multiple trainings and resources, all designed to help you learn more about POLST, and to develop and enhance your skills for facilitating meaningful conversations with patients and families about goals of care and POLST.
About the POLST/ACP Physician Leadership Council
The POLST/ACP Physician Leadership Council — an advisory group to the Coalition for Compassionate Care of California — is a group of California physicians, physician assistants and nurse practitioners representing multiple specialties who collaborate on POLST education and tools for healthcare professionals, patients, their families and others. Their goal is to assure that the health care wishes of Californians facing serious illness are elicited and honored. This group regards meaningful conversations among patients, families, and the healthcare team as the fundamental basis for advance care planning and the proper creation of the POLST form.
The POLST/ACP Physician Leadership Council promotes best practices in advance care planning and the use of POLST by:
- Educating professionals and community members about documenting goals of care conversations on the POLST form,
- Advising on POLST form development and quality improvement, and
- Supporting innovation in POLST and advance care planning education and outreach.
If you are interested in participating in the Physician Leadership Council, contacting a physician from this group for education or guidance about the POLST form, or have questions regarding a particular case, please Contact Us.
Get training on the California POLST from the California POLST experts at CCCC.
- POLST: It Starts with a Conversation is a two-day “train-the-trainer” program designed to help healthcare providers and organizations develop the skills necessary to have quality POLST conversations. Using the standardized California POLST curriculum, the program guides participants through the POLST form and uses role-playing exercises to model the complex scenarios that arise during end-of-life care discussions.
- POLST For Pediatrics – Conversations about end-of-life care are never easy, especially when the care concerns a seriously ill child. The Children’s Hospice & Palliative Care Coalition (CHPCC), together with the Coalition for Compassionate Care of California, developed a curriculum that teaches clinicians how to have sensitive, meaningful end-of-life care discussions with parents about their child. Released in 2012, the curriculum guides doctors, nurses, and other providers in using a POLST (Physician Orders for Life-Sustaining Treatment) form to record parents’ wishes for their child’s care in the final days of life.
24/7 Online Training
Working with POLST for Professionals: Education through the CSU Institute for Palliative Care
This 3-hour, online, self-paced course is designed to help healthcare professionals understand the role and value of POLST, and how to employ it in documenting and honoring patient wishes.
An optional 3 Continuing Education units (CEs) are available for purchase for an additional $25.00. See website for more course details.
In 2014, Assembly Bill 637 was enacted, allowing physician assistants and nurse practitioners acting under the supervision of a physician and within the scope of practice authorized by law to sign POLST.
Handout: What You Need to Know About AB 637 and POLST (PDF)
FAQ: Changes to POLST under AB 637 (PDF)
Watch: Webinar about Changes to POLST under AB 637 (View for free on Teachable)
Download: Webinar Slides About Changes To POLST In 2016 (PDF)
FAQ: Answers to questions asked during the live webinar about POLST under AB 637 (PDF)
Decision Guides is an educational series designed by the Coalition for Compassionate Care of California that explains the complex topics of life-sustaining treatments, using consumer-friendly language with evidence-based information. The Guides were developed with the help and guidance of healthcare professionals, and reflect the latest research on these interventions.
The Guides are recommended for use by healthcare professionals who treat seriously-ill patients in hospitals, palliative care units, skilled nursing facilities, hospices and medical groups. The Guides are intended to supplement conversations between patients and healthcare providers.
TOPICS INCLUDE: artificial hydration, cardiopulmonary resuscitation (CPR), mechanical ventilation, and tube feeding.
LANGUAGES: English, Chinese, Spanish and Vietnamese
Communication Tools & Resources
Helpful Phrases for Having the POLST Conversation / Frases útiles para usar en las conversaciones sobre POLST (PDF)
This guide walks healthcare providers through the most commonly used phrases in walking a patient and family through conversations about the POLST form. The guide includes phrases and questions in English and Spanish.
Using POLST with the Pediatric Population (PDF)
The Family Advisory Council of the Children’s Hospice and Palliative Care Coalition, along with key pediatric palliative care providers and the Coalition for Compassionate Care of California, developed recommendations for discussing Physician Orders for Life-Sustaining Treatment (POLST) with families of seriously ill children.
POLST QAPI Toolkit
Designed to provide skilled nursing facilities with useful, QAPI-based tools which can be used to improve POLST utilization in California’s nursing homes and assure that residents’ end-of-life treatment wishes are understood, documented and followed.
Download the QAPI Toolkit as a PDF
What is QAPI?
QAPI stands for Quality Assurance and Performance Improvement.
QAPI is a data-driven, proactive approach to improving the quality of life, care, and services in nursing homes. The activities of QAPI involve members at all levels of the organization to: identify opportunities for improvement; address gaps in systems or processes; develop and implement an improvement or corrective plan; and continuously monitor effectiveness of interventions.
Effective QAPI programs are critical to improving the quality of life, and quality of care and services delivered in nursing homes.
- AB 3000 (2008) – Implementing POLST
- AB 637 (2015) – Authorizing NP/PA Signature on POLST
- SB 19 (2015) – Authorizing POLST eRegistry Pilot
POLST SNF and RCFE Regulation (PDFs)
- AFL 14-20 / 9-9-2014 –MDS 3.0 “Section S” Coding Updates
- AFL 11-26 / 3-28-2011 – MDS 3.0 “Section S” Submission and Coding Updates
- AFL 10-42 / 11-16-2010 – MDS 3.0 “Section S” Submission and Coding Issues
- AFL 10-25/ 10-01-2010 – MDS 3.0 “Section S” and POLST
- AFL 9-27/ 12/03/2009 –POLST Implementation
- AFL 8-29/ 10-08-2009 – POLST Implementation
- Transmittal 09APX-03/02-2009 – RCFE Summary and Implementation Plan for POLST (Appendix A)