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 and 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 limited instructions for future life-sustaining treatments, respectively. Advance Directives are recommended for all adults, regardless of their health status.

The POLST is 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 also a legal document, but expresses a patient’s wishes as medical orders so that health care providers can readily apply them to the patient’s treatment. Emergency medical services will honor POLST directives and will not perform CPR if directed by the POLST form; the State issued salmon-colored DNR identification is no longer required. The POLST form also summarizes organ donation status, (as noted on a Nevada driver’s license or state issued ID) and who to contact should a patient be unable to express themselves (the Agent as stated in their Durable Power of Attorney for Health Care). If a POLST is completed for a patient, be sure to include the information from their other ADs 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 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 Living Will Lockbox. This service only stores Advance Directives and POLSTs. 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 Living Will Lockbox where it will be available 24/7.