Triad Vii

Abstract

In the Pennsylvania prehospital setting, POLST documents can be confusing, presenting a risk to patient safety. Additional research, standardized education, training, and/or safeguards are required to facilitate patient choice and protect safety.

The Problems With Physician Orders for Life-Sustaining Treatment

“…7 ,8 Thus, these studies yield 2 concerning conclusions. First, by allowing potentially confusing combinations of orders, POLST could cause patients to receive care that is either more or less aggressive than patients preferred when the documents were completed.…”

“…In the recent TRIAD VI and VII studies, 7, 8 emergency physicians (n = 223) and out-of-hospital personnel(n = 1069) were asked to interpret sample POLST forms with different combinations of orders. Study participants were then asked to state how they would treat a patient who presented with each form.…”

“…Of the 5 forms evaluated by out-of-hospital personnel, only the form specifying that clinicians should attempt CPR and provide full medical treatment yielded a consistent response among 95% of the clinicians. 8 All other order combinations of resuscitation and medical intervention orders resulted in inconsistent interpretations. For example, only 616 (58%) of 1059 out-of-hospital personnel 8 and 97 (51%) of 191 emergency physicians 7 stated that they would refrain from resuscitating a patient found in cardiac arrest with a POLST specifying DNR and full medical treatment.…”

Patient safety incidents in advance care planning for serious illness: a mixed-methods analysis

“…Previous studies have demonstrated a lack of confidence and knowledge about ACP among GPs affecting the initiation of ACP 49 and among paramedics affecting interpretation of ACP. 50 Our study adds further evidence demonstrating that lack of staff understanding of ACP can contribute to unsafe and inappropriate care. More research is needed to understand how to enable clinicians to create and use high-quality ACP to guide decision-making.…”

Factors associated with combined do-not-resuscitate and do-not-intubate orders: A retrospective chart review at an urban tertiary care center

“…In the recent TRIAD VI and VII studies, health care workers inconsistently followed Physician Orders for Life Sustaining Treatment for any combination of directives other than full medical treatment and CPR. [25, 26] DNR status may be interpreted as intent to avoid other life-sustaining therapies, such as intubation, despite the fact that many patients who are documented as DNR/DNI express a desire to be intubated for more readily reversible processes such as pneumonia and angioedema. [27] Given the importance to patients of outcomes when weighing medical interventions, it is vitally important that providers capture the disparate indications and outcomes for MV and CPR when discussing code status.…”