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Keywords:

  • ethics;
  • end of life;
  • comfort care;
  • palliative care;
  • nursing facility

Objectives

To evaluate the consistency between treatments provided and Physician Orders for Life-Sustaining Treatment (POLST) orders.

Design

Retrospective chart abstraction.

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 abstracted. 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.