TRIAD XII: Are Patients Aware of and Agree With DNR or POLST Orders in Their Medical Records

Abstract

This study contributes to the current body of research in this area by examining the most current data, a more robust sample, and a methodology that allows analysis of actual rather than extrapolated last-year-of-life expenses. The analysis has shown current trends in decedent/survivor costs, their relationship to each other, and the changes in this relationship over time. In addition, the finding that the relationship has changed to varying degrees by age groups provides the impetus for including age, gender, and decedent/survivor refinements into the current Medicare projection methodology.

TRIAD XI: Utilizing simulation to evaluate the living will and POLST ability to achieve goal concordant care when critically ill or at end‐of‐life—The Realistic Interpretation of Advance Directives

“…Resuscitation pause checklists have been created and recommended but utilization has not been widespread 26 . Patient safety DNR & POLST order verifications tools have been created, published, and show promise but have not been adopted or validated in larger scales 13 . With error rates shown in larger more established systems adoption would seem prudent 21 .…”

“…26 Patient safety DNR & POLST order verifications tools have been created, published, and show promise but have not been adopted or validated in larger scales. 13 With error rates shown in larger more established systems adoption would seem prudent. 21 Research utilizing audio alone or audio and video show great promise.…”

“…More recently, Lee et al confirmed over treatment errors with POLST range from 14% to 20% depending on the formatting of choices designated on the POLST 12 . Both TRIAD XII and previous POLST quality research, suggests an absence of consensual interpretation of POLST documents thus creating risk to patients 13,14 . The absence of patient concordance and provider consensus further supports the lack of clarity of the POLST.…”

“…12 Both TRIAD XII and previous POLST quality research, suggests an absence of consensual interpretation of POLST documents thus creating risk to patients. 13,14 The absence of patient concordance and provider consensus further supports the lack of clarity of the POLST.…”

The Importance of Clarity for Hospital Code Status Orders

“…In addition, during prior discussions, either at the time of completing a POLST form as an outpatient or even during a prior code status discussion during the current hospitalization, patients or surrogates may not have understood these discussions. 6 At the same time, we have to balance the risk of potential trauma of unnecessarily repeating a confirmed, high-quality, and well-documented discussion. Having different providers confirm well-established code status multiple times during a hospitalization is unnecessary and potentially harmful.…”