A POLST (Physician Orders for Life-Sustaining Treatment) form is an incredibly important medical document designed to outline your specific medical preferences, so it’s crucial to fill it out correctly.

Failing to do so can cause your POLST form to be considered invalid. Read on to learn how to correctly fill it out so your healthcare preferences are respected and understood. 

Key Takeaways 

• Patients cannot complete POLST forms. It’s the healthcare provider’s responsibility.

• Three decisions will need to be made in the form: the use of CPR, the level of medical intervention, and the use of artificial nutrition.

• POLST forms should be updated after health changes, changing healthcare providers, changes in personable values, changes in treatment, and regular checkups.

Step-by-Step Guide to Filling Out a POLST Form

Before you can begin the process of completing your POLST form, it is crucial to remember that this medical document was not created for patients to fill out. Your physician must fill out your POLST form according to your medical preferences. 

Step 1: Gather Your Information and Materials

To begin, gather and bring all the relevant materials to your healthcare provider's consultation. 

You'll need a valid ID and a detailed medical history, including vaccinations, diagnoses, medications, and treatment plans. Also, gather updated contact information for your healthcare team and emergency contacts.

Your healthcare provider must complete the POLST form and help you understand your condition, prognosis, and the impact of your choices. They ensure your decisions align with your medical needs and personal values.

Step 2: Section A – Cardiopulmonary Resuscitation (CPR)

This section is crucial in emergencies. First responders check for a pulse and need to know if CPR is desired or if a Do Not Resuscitate (DNR) order is in place.

Many patients forgo CPR because of how physically traumatic the experience can be. Some studies show that for patients suffering from serious health conditions or life-threatening conditions, CPR can do more harm than good. 

Kathleen Cameron, former senior director of NCOA’s Center for Healthy Aging, explains:

 “It’s important to know that CPR is a traumatic procedure. Popular culture doesn’t usually talk about it this way, but CPR often can do more harm than good—especially for certain people who already are near the end of life.” 

CPR involves pushing hard onto the patient’s chest to get the heart started, and sometimes, other methods like electrical shock (defibrillation), intubation, and ventilation are used. Common injuries from CPR include broken ribs, skeletal chest injuries, aspiration, vomiting, abdominal distension, aspiration pneumonia, and internal brain injuries due to a lack of blood circulation. 

If you wish to avoid these complications, your provider will mark your choice as NO CPR: DO NOT ATTEMPT RESUSCITATION. So, when is CPR a good idea? 

CPR might be more suitable for patients in good health, whose bodies can withstand the physical impact, and who want lifelong efforts. Individuals without pre-existing medical conditions like osteoporosis, bleeding disorders, or previous chest surgeries have a better chance of not experiencing the negative side effects of CPR. 

Step 3: Section B – Medical Interventions

Section B of the POLST form outlines what type of care you want to receive at the hospital. During this stage, your healthcare provider will spend a good amount of time discussing the implications of your choices and what to expect according to your medical preferences. 

In this section, you will have three types of care to choose from: 

• Full treatment: If you selected yes for CPR, this option must be chosen. Full treatment means that healthcare providers can do everything medically necessary to help you, like admit you to the intensive care unit (ICU), insert a breathing tube, or put you on a ventilator.

• Selective treatments: If you’re okay with going to the hospital but don’t want to be put on a ventilator, this is the recommended choice. This type of treatment includes antibiotics or fluids and medications being received through an IV tube. This is a good option for someone with a stable chronic treatment looking for limited treatment to avoid being hospitalized.

• Comfort-focused treatments: While all treatments provided are comfort-focused, this means staying where you are if you are comfortable. This is a good option for patients who are terminally ill and are focused on quality of care over the quantity of life.  

Step 4: Section C – Artificially Administered Nutrition

The third choice is whether you wish to receive nutrition via a feeding tube and for how long. The reason why this is included is because some feeding tubes may require surgery to place them if the patient is on them for more than two weeks. 

There are four choices to choose from: 

• Provide feeding through new or existing surgically-placed tubes 

• Trial period for artificial nutrition but no surgically-placed tubes 

• No artificial means of nutrition is desired 

• Not discussed or no decisions made (provide the standard of care) 

Your healthcare provider will discuss the potential benefits and drawbacks of each option. For example, feeding tubes can cause mild discomfort, changes to body functions like digestion, and complications like infections and tears in the intestines. 

Other complications include skin irritation, reflux, and aspiration pneumonia. Knowing all the potential pros and cons can help you make confident decisions.  

Step 5: Section D – Signatures

For your POLST to be valid, signatures from you or your surrogate and your healthcare provider are needed. These signatures mean you understand having a POLST form is entirely voluntary and that you’ve discussed your decisions with your healthcare provider. 

The signature requirements vary by state, so check your state’s requirements to ensure the validity of your POLST form. 

Step 6: Review and Confirm

Carefully read through your POLST form and double-check that all information is correct, reflects your wishes, and that you fully understand the consequences of each of your decisions.

Now is the time to voice any lingering questions or concerns before your healthcare provider distributes copies of your POLST form. You can also check that you have provided additional orders, like blood products or dialysis, that may limit first responders. 

Where to Store and Share Your Completed POLST Form

Dr. Sandip Sachar, a dentist in NYC with experience and training in medical emergencies, explains:

 “Once you've completed your POLST (Physician Orders for Life-Sustaining Treatment) form, it's crucial to keep it accessible. If you're at home, post it on your refrigerator or keep it in your medicine cabinet, as emergency personnel will look for it in these places. If you travel, carry a copy in your purse or wallet near your ID. Additionally, some states offer electronic POLST registries, which securely store your POLST form and make it accessible to healthcare providers across different facilities.”

Doctors will keep copies of the medical order in your medical records at healthcare facilities, but what about your digital copies? Store these essential medical documents in a secure digital vault like Trustworthy. Trustworthy’s life-changing Family Operating System® is designed to get and keep families organized. The AI-powered Autopilot feature has tools that make uploading and organizing your documents hassle-free. The predefined categories mean you don't have to create a filing system from scratch. 

Bank-level security features like AES 256-bit encryption, multi-factor authentication, biometric authentication, physical security keys, on-screen redaction, tokenization, and advanced threat detection to keep your documents protected.  

Trustworthy also comes in handy when providing access to caregivers and family. Create a network of trusted collaborators on your account and provide full or partial access to your POLST form. Share your document with people outside of your network using the SecureLinks™ feature. Create unique, view-only links and limit how long these links are valid for ultimate control over your documents.  

Common Mistakes to Avoid

Ensure your POLST form is valid by consulting your healthcare provider. Their expertise helps you understand terminology, treatment options, and the impact of your choices.

Incomplete or unclear forms can cause confusion, delays, or unwanted treatment, so fill out all sections clearly and accurately.

Updating Your POLST Form

Your POLST form reflects your current health status, medical preferences, and personal values, which will evolve. It must be updated as your needs and wishes change. 

Update your POLST form after: 

• Health changes: Changes in your condition, new diagnosis, medications, and treatment plans are a good time to update your POLST.

• Changes in personal values and treatment preferences: Our values, goals, and priorities will shift over time, especially when dealing with illnesses. Perhaps you want to pursue more aggressive curative treatments or focus on hospice care. You need to update your POLST form to reflect this.

• Changes in healthcare providers: If you have new healthcare providers or moved states, you will need to update your POLST form to ensure you meet state requirements.

• During routine reviews: Schedule regular discussions with your healthcare provider to ensure your POLST form is always accurate. You can use Trustworthy’s automated reminders to schedule these reviews. 

Notify your healthcare providers, family members, and medical power of attorney of updated POLST forms. To update your POLST form, you must schedule a consultation with your healthcare provider and fill out a new form. It is crucial to have your healthcare provider mark your old POLST form as void. 

Frequently Asked Questions  

Can a POLST form be used in all states?

No, each state will have its own POLST form signature requirements, so you must create a new POLST form if you move to a different state. 

Who should sign the form?

This will depend on your state’s signature requirements, but generally, you or your surrogate and your healthcare provider must sign the form. 

How often should the form be reviewed?

Your POLST form should be reviewed at least once a year or after checkups, health changes, and shifts in personal values.