The Consistency Between Treatments Provided to Nursing Facility Residents and Orders on the Physician Orders for Life-Sustaining Treatment Form

• Published in: Journal of the American Geriatrics Society (JAGS) Vol. 59; no. 11; pp. 2091 - 2099
• Main Authors: Hickman, Susan E., Nelson, Christine A., Moss, Alvin H., Tolle, Susan W., Perrin, Nancy A., Hammes, Bernard J.
• Format: Journal Article
• Language: English
• Published: Hoboken, NJ Blackwell Publishing Ltd 01-11-2011; Wiley-Blackwell; Wiley Subscription Services, Inc
• Subjects: Advance Care Planning; Advance Directive Adherence - standards; Advance Directives; Aged; Aged, 80 and over; Biological and medical sciences; comfort care; end of life; Ethics; Female; Follow-Up Studies; General aspects; Health care delivery; Health participants; Humans; Life Support Care - methods; Male; Medical Records - statistics & numerical data; Medical sciences; nursing facility; Nursing homes; Nursing Homes - statistics & numerical data; Palliative care; Patient Transfer - statistics & numerical data; Public health. Hygiene; Public health. Hygiene-occupational medicine; Quality of Health Care; Retrospective Studies; Withholding Treatment; Human; Health staff; nursing facility; Specialized institution; Physician; End of life; Care; Ethics; Gerontology; Treatment; Comfort; comfort care; Palliative care; Homes for the aged; Nursing home; Elderly; Public health; Geriatrics
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/j.1532-5415.2011.03656.x

Objectives
To evaluate the consistency between treatments provided and Physician Orders for Life‐Sustaining Treatment (POLST) orders.
Design
Retrospective chart ion.
Setting
Stratified, random sample of 90 nursing facilities in Oregon, Wisconsin, and West Virginia.
Participants
Eight hundred seventy living and deceased nursing facility residents aged 65 and older with a minimum 60‐day stay.
Measurements
Chart data about POLST form orders and related treatments over a 60‐day period were ed. Decision rules were created to determine whether the rationale for each treatment was consistent with POLST orders.
Results
Most residents (85.2%) had the same POLST form in place during the review period. A majority of treatments provided to residents with orders for comfort measures only (74.3%) and limited antibiotics (83.3%) were consistent with POLST orders because they were primarily comfort focused rather than life‐prolonging, but antibiotics were provided to 32.1% of residents with orders for no antibiotics. Overall consistency rates between treatments and POLST orders were high for resuscitation (98%), medical interventions (91.1%), and antibiotics (92.9%) and modest for feeding tubes (63.6%). In all, POLST orders were consistent with treatments provided 94.0% of the time.
Conclusion
With the exception of feeding tubes and antibiotic use in residents with orders for no antibiotics, the use of medical treatments was nearly always consistent with POLST orders to provide or withhold life‐sustaining interventions. The POLST program is a useful tool for ensuring that the treatment preferences of nursing facility residents are honored.