For Providers – What is the Difference between a POLST form and an Advance Directive (AD)?

What is the Difference between a POLST form and an Advance Directive (AD)?
The POLST form complements an Advance Directive (AD) and is not intended to replace any type of AD. Advance Directives (Durable Power of Attorney for Health Care, Living Will or Declaration) are legal documents and necessary in order to appoint a legal health care representative and provide general instructions for future life-sustaining treatments, respectively. Advance Directives are recommended for all adults, regardless of their health status.

The POLST is a medical order for the very frail elderly or those near the end of a progressive or terminal illness for whom their health care professional would not be surprised if they died within a year or so. The POLST is governed by Nevada statute and expresses a patient’s wishes as medical orders. Emergency medical services may only follow a medical order, such as a POLST. An AD is not a medical order; it provides general statements about future health care wishes. The State issued salmon-colored DNR identification, although still valid, is no longer required if a patient has a POLST form. The POLST form summarizes who to contact should a patient be unable to express themselves (the Agent as stated in their Durable Power of Attorney for Health Care – DPOA-HC). If a POLST is completed for a patient, be sure to include the information from their DPOA-HC on the POLST form (side 2).

The POLST should remain with the patient wherever they receive treatment. If they are at home, the POLST should be next to the patient’s bed or on their refrigerator, both locations where emergency medical service personnel are trained to look for it. The POLST form should be bright pink for easy recognition. If the patient’s form is white or another color, although it is still legal, the information on it should be transferred to a pink POLST to assure ready recognition by other providers.

Both the patient’s ADs and POLST should be submitted to a Health Information Exchange (HIE) to assure they are available to health care providers 24/7. There are two HIEs for Nevada. HealthInsight’s HealtHIE Nevada is a repository for an array of medical records and has been adopted by most major hospitals as well as labs, pharmacies, insurers and other providers in Nevada. Nevada Secretary of State has the Nevada Lockbox (previously the Living Will Lockbox). This service only stores Advance Directives, POLSTs and DNRs. When completing a POLST with a patient, be sure to have them sign a consent form for HealtHIE Nevada, if your organization is a member, or a Registration Agreement authorizing submission of their AD and POLST to the Nevada Lockbox where it will be available 24/7.

For additional information on the national POLST Paradigm, click here.