What you need to know about POLST

If you have severe illness or frailty, the Nevada POLST (Provider Order for Life-Sustaining Treatment) program will assure that you receive the medical treatments you want near the end of your life.

The Nevada POLST was enacted into law to assure your treatment wishes become medical orders that emergency medical services and your doctor are will honor. The medical orders on the POLST only become active if you lose the ability to say for yourself what you want.

POLST also helps you talk with your health care team and understand treatment options specific to your condition. It also helps you talk to your loved ones about your choices. In this way, POLST can help reduce patient and family confusion, misunderstandings and make sure that your wishes are known and honored.

POLST is not for everyone.
For healthy patients, an Advance Directive is an appropriate tool for making future end-of-life care wishes known to loved ones. The POLST is designed to ensure that seriously ill patients understand and can decide with their health care provider what treatments are most appropriate. Medical orders are written based on these decisions and those orders will then be honored by all medical providers.

Who should have a POLST?
Any seriously ill patient or the frail elderly should have a POLST form. Completing a POLST is entirely up to you. It’s your choice and completely voluntary.

What does POLST do?

  • POLST makes your treatment wishes known to all health care providers. Too often, patients near the end of their lives may get treatment they do not want. The default is to provide more aggressive care at the end of life, but these treatments may not help patients live longer or better. Sometimes this treatment can cause pain, and prolong the process of dying. POLST gives you a way to tell your healthcare team what types of treatment you may or may not want. (You may find these decision guides helpful). But, POLST is not intended to limit desired treatment; if you decide you would like more aggressive care, that is also a choice available on the POLST and is important for your health care providers and loved ones to know.
  • POLST makes your wishes clear to your family members and caregivers. Sometimes, family members have their own ideas about what types of treatment their loved ones would or would not want. POLST makes sure your family members and caregivers know what treatments you do and do not want. No one has to guess or feel burdened with making decisions for you.

Is POLST different from an Advance Directive?
Yes. An Advance Directive allows you to choose the person you want to speak for you, and provides a general guide to what you want. POLST is different because:

  • POLST tells your exact wishes about certain medical treatments;
  • POLST is a signed medical order that your health care team can act upon;
  • Emergency Medical Services (ambulance crews) are able to honor the orders of a POLST, however, they cannot, by law, honor an Advance Directive because it is not a medical order.
  • POLST goes with you to your home, the hospital, or long-term care facility. It goes where you go, so it is always available. However, to assure it is available in all instances, you may register it with the Nevada Secretary of State’s Nevada Lockbox

It is a good idea for the seriously ill and the frail elderly to complete an Advance Directive. There are two parts of an Advance Directive: Declaration, states what care you want or don’t want regarding resuscitation, nutrition and hydration in general terms, and a Durable Power of Attorney for Health Care (DPOA-HC) that names someone else to speak for you when you cannot speak for yourself. A POLST form offers specific levels of treatment that you may choose from and puts these in terms of a medical order. POLST also provides your health care provider information about organ donation and your Advance Directives, so should they need this information, it too is available.

Who can help me fill out a POLST form?
The POLST is the outcome of a meaningful conversation between you, your representative or surrogate decision-maker and your health care provider that reflects your current goals of care. Unlike an Advance Directive, and as a medical order, it should always be completed with a health care provider who can explain what the different options will mean to your quality and length of life. These decision guides may be helpful as you prepare for this discussion. The form must be signed and dated by a physician, advanced practice registered nurse (APRN) or physician assistant (PA) and by you or your legal representative or surrogate.

What do I do with my POLST form?
Once signed, the POLST form will be copied and become part of your medical record, but the original pink form stays with you all the time.

  • If you are at home, put it near your bed or on your refrigerator so it is readily available if needed.
  • If you are in a hospital, nursing home, or assisted living facility, it will be in your chart or file.
  • If you are moved between locations, your POLST form will go with you.
  • To assure your POLST and Advance Directive are available 24/7, you may register them with the Nevada Secretary of State’s Nevada Lockbox. You will receive a wallet card to carry that, in an emergency, will provide quick access to these important documents.

What if I want to change my POLST form?
You and your healthcare provider can change your POLST form whenever you want or whenever medically necessary. If you have your POLST registered with the Secretary of State’s Nevada Lockbox, you should submit the change to the lockbox using this form.

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