Use of the Physician Orders for Life-Sustaining Treatment program in Oregon nursing facilities: beyond resuscitation status.
OBJECTIVE
Program was designed to communicate resident/surrogate treatment preferences in the form of medical orders. To assess statewide nursing facility use of the Physician Orders for Life-Sustaining Treatment (POLST) and to identify the patterns of orders documented on residents' POLST forms.


METHODS
Telephone survey; on-site POLST form review.


METHODS
Oregon nursing facilities.


METHODS
One hundred forty-six nursing facilities in the telephone survey; 356 nursing facility residents aged 65 and older at seven nursing facilities in the POLST form review.


METHODS
A telephone survey; onsite POLST form reviews.


RESULTS
In the telephone survey, 71% of facilities reported using the POLST program for at least half of their residents. In the POLST form review, do-not-resuscitate (DNR) orders were present on 88% of POLST forms. On forms indicating DNR, 77% reflected preferences for more than the lowest level of treatment in at least one other category. On POLST forms indicating orders to resuscitate, 47% reflected preferences for less than the highest level of treatment in at least one other category. The oldest old (> or = 85, n=167) were more likely than the young old (65-74, n=48) to have orders to limit resuscitation, medical treatment, and artificial nutrition and hydration.


CONCLUSIONS
The POLST program is widely used in Oregon nursing facilities. A majority of individuals with DNR orders requested some other form of life-extending treatment, and advanced age was associated with orders to limit treatments.
Hickman
Susan E
SE
School of Nursing, Oregon Health & Science University, Portland, Oregon 97239, USA. hickmans@ohsu.edu
Tolle
Susan W
SW
Brummel-Smith
Kenneth
K
Carley
Margaret Murphy
MM
D032722:Advance Care Planning / Q000458:organization & administration*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D002755:Choice Behavior; D004750:Enteral Nutrition; D005440:Fluid Therapy; D005568:Forms and Records Control; D019983:Guideline Adherence; D006302:Health Services Research; D006801:Humans; D008020:Life Support Care / Q000458:organization & administration* / Q000523:psychology; D008485:Medical Audit; D008499:Medical Records; D009735:Nursing Homes / Q000458:organization & administration*; D009922:Oregon; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000458:organization & administration*; D016414:Resuscitation Orders / Q000523:psychology; D011795:Surveys and Questionnaires
D000900:Anti-Bacterial Agents