What is the Difference between a POLST form, an Advance Directive (AD) and a DNR?
The POLST form complements an Advance Directive (AD) and is not intended to replace any type of AD. A Do Not Resuscitate (DNR) order only governs the withholding of resuscitation (this is when your heart stops and vigorous compressions are attempted to re-start it). There are two types of DNRs, one is only for when a patient is in a healthcare facility and the other is if a patient is outside of a healthcare facility.
A Nevada POLST is both a legal document and a medical order intended for those near the end of a serious illness or with advanced frailty; it is not for everyone. The POLST order directs treatment regarding resuscitation (if the heart stops), artificial nutrition and hydration and three levels of treatment for those nearing the end of life. Because it is a medical order, it will be honored by all healthcare providers in all settings, both in and out of a health care facility or during transport. The POLST form also notes who is legally able to speak for you should you be unable to express your own wishes (see DPOA-HC, next paragraph). If you complete a POLST, be sure this contact information is supplied on the POLST form.
The POLST should remain with you wherever you receive treatment. If you are at home, the POLST should be next to your bed or on your refrigerator, both are locations that emergency medical service personnel are trained to look for it. The POLST form should be bright pink. Although valid, if your form is white or another color, ask your healthcare provider if it is possible to have a pink one to assure ready recognition by other providers.
An Advance Directive is a legal document, but not a medical order. It has two parts: a Durable Power of Attorney for Health Care (DPOA-HC) and a Declaration. A DPOA-HC specifies who legally may speak for a patient who cannot express their wishes themselves. The Declaration provides limited instructions for future life-sustaining treatments. Unlike a POLST that is for those near the end of life, an AD is recommended for all adults, regardless of their health status. However, it is important to know that wishes expressed in an AD cannot be honored by emergency medical services (EMS/ambulance) personnel because an AD is not a medical order.
Once completed, your Advance Directive should be copied and given to your physician and DPOA-HC, or anyone else who may be contacted in an emergency. If you have not yet completed these important documents you may do so online at NVLivingWill.com. The advantage of using NVLivingWill.com is that:
It explains some of the legal language (simply click on the small, circled "i" [information] symbols),
If you make incompatible choices, it lets you know,
It prints out a clear, legible document (often, although people have taken the time to complete an AD, it isn't legible, so is not useful), and;
If you want to make a change, you don't need to complete an entirely new AD, just change what you want and print it out.
Or, you may want to consider another format for end-of-life decision making, Five Wishes.
A DNR (Do Not Resuscitate) order is only effective during a stay in a healthcare facility (hospital, nursing home, etc.). Outside of a hospital (at home, while traveling, etc.) a special DNR is required, an EMS-DNR, also known as an Out-of-hospital DNR (also known as a DNR Identification, Pre-hospital DNR or EMS-DNR). The DNR Identification may only be completed for those diagnosed with a terminal illness. It only governors the withholding of resuscitation, no other treatments. An application form signed by the patient and their physician is sent to the State. Upon approval, the State sends the individual an identification card to keep on their person, directing that NO resuscitation be administered.
An Out-of-hospital DNR is only valid outside of a facility. It requires a terminal diagnosis and a $5.00 fee, then submission to the State in order to receive the identification. If admitted to a facility, the order is no longer valid and must be re-evaluated by the admitting physician and re-ordered as a regular DNR. An Out-of hospital DNR should be kept in the patient’s wallet or, otherwise, near the patient at all times so in an emergency it will be available to Emergency Medical Service (ambulance) personnel.