Thursday, June 20, 2013

Advance Directives, DNR, POLST: What does it all mean?

Advance Directives, DNR, POLST: What does it all mean?

     It can be difficult and overwhelming to discuss end of life choices. Hospice of Southern Illinois can help you navigate the tangled web of information surrounding all these issues and be a resource for people who need assistance making healthcare decisions. It is best to do this sooner, rather than later, so you are not called upon to make these decisions during a time of crisis. When people hear the terms Advanced Directives, or DNR, they tend to think of death and terrible circumstances. It doesn’t have to be that way. Planning for your future should make it easier for you and your family to have some control and to have a plan at a difficult time. Let us help by defining some of the terms and also to explain the newest type of Advance Directive called the POLST form.

     Advanced Care Planning involves discussing your wishes for end of life care and defining a set of legal documents stating those wishes. This includes a Healthcare Power of Attorney (POA) and a Living Will. These are also called Advance Directives. These documents clarify what you or your loved one would want to happen, if you became critically ill. In other words, if you should stop breathing or your heart would stop, what would you want done to you. Not everyone is comfortable discussing these issues. They should be discussed with your physician. You should understand what you are talking about and when these documents become effective. Among the forms being discussed are the Do Not Resuscitate Form (DNR) and a newer form called the POLST form. DNR forms differ from state to state and primarily deal with the patient’s wishes if they have no pulse (their heart stops). It directs the health care providers to either Do or Not Do CPR (Cardiopulmonary Resuscitation) in the event of death.  POLST stands for Physician’s Order for Life Sustaining Treatment. It is becoming widely accepted in many states.  The purpose of developing the new POLST form was twofold: First, to standardize a DNR form from state to state that would be universally accepted; Second, to help direct care before CPR is needed, and to know the wishes of the patient at a time of medical crisis. All healthcare professionals in Illinois are now being taught how to discuss, help implement and accept the POLST form. It will eventually replace the DNR form but is just becoming known in this region. If you have a DNR form you do not need to have a POLST form, but you may be asked about it.
     The DNR form is still widely available and it is still being accepted as a legal document.  However, it limits the authority to act to a time when the patient actually dies, in other words, when their heart stops. It does not give instructions if you are critically ill, or for instance, you might require long term ventilation support and/or tube feeding/artificial food and hydration to survive.  We would like to explain the new POLST form in more detail.

·         The first difference is that it has one section (A) for CPR;
·         The second section (B) is for Medical Interventions and the extent you wish –(If you are critically ill but still have a pulse) to be treated.  It defines the following terms/levels of care;  
      - Comfort Measures to relieve pain and suffering;
      - Somewhere in the middle, you may want “Limited Additional Intervention for IV Fluids and less invasive airway support like CPAP or BiPap, (external devices that assist with breathing);
     -  Or would you want to be Intubated and Mechanical Ventilation started; You would likely be sent to the Intensive Care Unit and everything would be done, per your wishes;
·         The 3rd section (C) allows you to choose if you would want artificial food by feeding tube or just to be fed by mouth if possible, No Artificial Feeding, if you cannot take food by mouth;
·         Section D is for documentation of the person who signs the form: yourself, Parent, Health Care Power of Attorney; or Surrogate decision maker;
·         Section E if for the Attending Physician to sign. This document is not complete unless your Attending Doctor signs it;
·         The back of the form is optional and revolves around other forms you may have and who helped the patient fill out the form.

     When completed, any or all of your Advance Directives should be filled out and kept in a place where you can get to them quickly. Make copies and give one to your physician, your family members and possibly your closest friends.

     For more information or for help filling out these forms: Go to the following links:
     Help us share, educate, and reach out by subscribing to our blog and suggesting it to friends who will spread our message: Hospice of Southern Illinois is here to teach you what hospice is, what we are about, and what we can do for you and your loved ones. No one has to go through the dying process alone. Hospice of Southern Illinois can help.

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