The consistency between treatments provided to nursing facility residents and orders on the physician orders for life-sustaining treatment form.

To evaluate the consistency between treatments provided and Physician Orders for Life-Sustaining Treatment (POLST) orders. Retrospective chart abstraction. Stratified, random sample of 90 nursing facilities in Oregon, Wisconsin, and West Virginia. Eight hundred seventy living and deceased nursing facility residents aged 65 and older with a minimum 60-day stay. Chart data about POLST form orders and related treatments over a 60-day period were abstracted. Decision rules were created to determine whether the rationale for each treatment was consistent with POLST orders. 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. 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.

Hickman SE ，Nelson CA ，Moss AH ，Tolle SW ，Perrin NA ，Hammes BJ ... -  《-》

A prospective study of the efficacy of the physician order form for life-sustaining treatment.

Tolle SW ，Tilden VP ，Nelson CA ，Dunn PM ... -  《JOURNAL OF THE AMERICAN GERIATRICS SOCIETY》

A comparison of methods to communicate treatment preferences in nursing facilities: traditional practices versus the physician orders for life-sustaining treatment program.

Hickman SE ，Nelson CA ，Perrin NA ，Moss AH ，Hammes BJ ，Tolle SW ... -  《-》

Use of the Physician Orders for Life-Sustaining Treatment program in Oregon nursing facilities: beyond resuscitation status.

Program was designed to communicate resident/surrogate treatment preferences in the form of medical orders. To assess statewide nursing facility use of the Physician Orders for Life-Sustaining Treatment (POLST) and to identify the patterns of orders documented on residents' POLST forms. Telephone survey; on-site POLST form review. Oregon nursing facilities. One hundred forty-six nursing facilities in the telephone survey; 356 nursing facility residents aged 65 and older at seven nursing facilities in the POLST form review. A telephone survey; onsite POLST form reviews. In the telephone survey, 71% of facilities reported using the POLST program for at least half of their residents. In the POLST form review, do-not-resuscitate (DNR) orders were present on 88% of POLST forms. On forms indicating DNR, 77% reflected preferences for more than the lowest level of treatment in at least one other category. On POLST forms indicating orders to resuscitate, 47% reflected preferences for less than the highest level of treatment in at least one other category. The oldest old (> or = 85, n=167) were more likely than the young old (65-74, n=48) to have orders to limit resuscitation, medical treatment, and artificial nutrition and hydration. The POLST program is widely used in Oregon nursing facilities. A majority of individuals with DNR orders requested some other form of life-extending treatment, and advanced age was associated with orders to limit treatments.

Hickman SE ，Tolle SW ，Brummel-Smith K ，Carley MM ... -  《JOURNAL OF THE AMERICAN GERIATRICS SOCIETY》

Do Life-sustaining Treatment Orders Match Patient and Surrogate Preferences? The Role of POLST.

Hickman SE ，Torke AM ，Sachs GA ，Sudore RL ，Tang Q ，Bakoyannis G ，Smith NH ，Myers AL ，Hammes BJ ... -  《-》