Quality of Physician Orders for Life-Sustaining Treatment Forms Completed in Nursing Homes

Rahman, Anna; Bressette, Matthew; Enguídanos, Susan

doi:10.1089/jpm.2016.0280

Cited by 15 publications

(15 citation statements)

References 10 publications

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“…12 In our study, MOST forms were most commonly invalid because of logistical problems with form completion, although 16% still had an inappropriate care preference selection. This is higher than other rates of inconsistent treatment preferences, ranging from 5.6% to 7.3%, and represents a need for consistent interdisciplinary training and quality monitoring to ensure that MOST forms are appropriately implemented in subacute rehabilitation.…”

Section: Discussionmentioning

confidence: 61%

See 1 more Smart Citation

Use of Medical Orders for Scope of Treatment for Heart Failure Patients During Postacute Care in Skilled Nursing Facilities

Lum

Obafemi

Dukes

et al. 2017

Journal of the American Medical Directors Association

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Background Individuals with heart failure (HF) who are hospitalized and admitted to skilled nursing facilities (SNFs) are at high risk for rehospitalization and death. The care preferences of this high-risk population have not been studied. Objectives To describe care preferences of patients with HF admitted to SNFs for rehabilitation based on Medical Orders for Scope of Treatment (MOST) documentation, and evaluate goal-concordant care based on MOST documentation, emergency department (ED) visits, and hospitalization. Design, setting, and participants Retrospective study of patients with HF in 35 SNFs enrolled in a randomized controlled trial of HF-disease management versus usual care between July 2014 and May 2016. Measurements Validity of MOST forms, care preference documentation, and ED visits/hospitalizations within 60 days of SNF admission. Results Of 370 patients (mean age 78.6 years, 58% women, 25% systolic HF), 278 (75%) had a MOST form in the SNF chart, of which 96 forms (35%) were invalid. The most common reason for an invalid MOST form was missing date accompanying patient or provider signature. Of 182 valid MOST forms, 47% of patients chose no cardiopulmonary resuscitation (“No CPR”), 58% selected “Full Treatment,” 17% chose “Selective Treatment,” and 23% chose “Comfort-Focused Treatment.” Patients who were older [odds ratio (OR) = 1.50, 95% confidence interval (CI) = 1.25, 1.81] and female (OR = 2.33, 95% CI = 1.18, 4.59) had higher odds of choosing “No CPR.” Sixty-six of 182 patients (36%) with valid MOST forms had an ED/hospital visit within 60 days of SNF admission; only 3 patients received medical care that was potentially discordant: all 3 chose “Comfort-Focused Treatment” and were hospitalized for more than symptom management. Conclusion Seventy-five percent of patients with HF admitted to SNFs had care preferences documented using the MOST form, and 95% received goal-concordant care based on care preferences documented during the SNF admission. Clinicaltrials.gov # NCT01822912.

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Section: Discussionmentioning

confidence: 61%

“…This is higher than other rates of inconsistent treatment preferences, ranging from 5.6% to 7.3%, and represents a need for consistent interdisciplinary training and quality monitoring to ensure that MOST forms are appropriately implemented in subacute rehabilitation. 12,13 …”

Section: Discussionmentioning

confidence: 99%

Use of Medical Orders for Scope of Treatment for Heart Failure Patients During Postacute Care in Skilled Nursing Facilities

Lum

Obafemi

Dukes

et al. 2017

Journal of the American Medical Directors Association

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“…In addition, low POLST form completion rates among patients without PPC consultation may be because of providers' lack of familiarity with POLST forms. 18,19 Another notable finding of our study was the relationship between PPC consultation and documentation of mental health disorders. With the documentation of mental health disorders after PPC consultation, it is suggested that PPC consultation may lead to increased identification of mental health disorders, perhaps facilitated when a PPCtrained social worker and/or a psychologist are team members.…”

Section: Discussionmentioning

confidence: 67%

Associations Between Pediatric Palliative Care Consultation and End-of-Life Preparation at an Academic Medical Center: A Retrospective EHR Analysis

Stutz

Kao²,

Huard³

et al. 2018

Hospital Pediatrics

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“…However, improvement in the quality of POLST forms is needed. In a study of 938 POLST forms in California nursing homes, 30.4% of POLST forms for residents were not complete or documented clinically contradictory treatment preferences (Rahman et al 2017).…”

Section: Medical Orders At End Of Life (Molst Polst)mentioning

confidence: 99%

Advance Care Planning: Medical Orders at the End of Life (MOLST, POLST)

Bomba¹

2020

Encyclopedia of Gerontology and Population Aging

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Medical orders for life-sustaining treatment (MOLST); Medical orders for scope of treatment (MOST); Physician orders for life-sustaining treatment (POLST); Physician orders for scope of treatment (POST); POLST paradigm program (PPP); Portable medical orders for life-sustaining treatment (POLST); Provider orders for life-sustaining treatment (POLST) Definition Advance Care Planning Advance care planning (ACP) is a communication process that aims to help an individual plan for future medical care if the person is unable to make his or her own medical decisions. An estimated 45-70% of older adults facing end-oflife (EOL) treatment decisions are incapable of making those decisions themselves (Institute of Medicine [IOM] 2014). ACP helps an individual prepare for a sudden unexpected illness or injury, from which the person may recover, as well as the dying process and ultimately death. The goal of ACP is to ensure that individuals receive care consistent with their expressed preferences during serious and chronic illnesses (Sudore et al. 2017). An additional goal of ACP is to ensure the desired care will help the person live well as death approaches and die in their preferred setting. ACP applies to all adults 18 years of age and older. ACP empowers a person to authorize a trusted individual to make future health decisions if and only if the person cannot do so and to share personal values, beliefs, and what matters most ahead of time. Advance directives (AD) are legal documents completed at the end of the ACP process that outline a plan for future care in the event a person loses the ability to make medical decisions, like the healthcare proxy (HCP) or durable power of attorney for health care (DPAHC) and the living will (LW). Medical Orders at the End of Life Medical orders at the end of life are patient-centered decisions that outline current patient preferences for cardiopulmonary resuscitation in the event of cardiac and/or pulmonary arrest as well as preferences in the event of cardiac and/or pulmonary insufficiency, including but not limited to ventilator support, hospitalization, artificial hydration and nutrition, antibiotics, dialysis, blood transfusions, etc. Creation of a set of medical orders is based on a thoughtful discussion and/or series of discussions with the seriously ill

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Quality of Physician Orders for Life-Sustaining Treatment Forms Completed in Nursing Homes

Abstract: We found 30.4% of POLST forms for nursing home residents were not complete or documented clinically contradictory treatment preferences. Improvement in the quality of POLST forms is needed.

Cited by 15 publications

References 10 publications

Use of Medical Orders for Scope of Treatment for Heart Failure Patients During Postacute Care in Skilled Nursing Facilities

Use of Medical Orders for Scope of Treatment for Heart Failure Patients During Postacute Care in Skilled Nursing Facilities

Associations Between Pediatric Palliative Care Consultation and End-of-Life Preparation at an Academic Medical Center: A Retrospective EHR Analysis

Advance Care Planning: Medical Orders at the End of Life (MOLST, POLST)

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