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December 1, 2020

Oregon POLST® Program News
POLST Guidebook for Health Care Professionals Updated to Clarify 'CPR/Limited Treatment'
The Oregon POLST Registry currently accepts POLST forms with Section A designating ‘Attempt Resuscitation/CPR’ and Section B ‘Limited Treatment.' Additionally, Oregon EMS providers continue to honor forms with this order combination in the field. The Oregon POLST Coalition acknowledges that an order for ‘CPR/Limited Treatment’ can be confusing, since those who survive CPR usually receive intubation and ventilation as a standard part of in-hospital resuscitation.
Image of cover to POLST Guidebook for Health Care Professionals
To support those health systems that wish to place restrictions on the use of this order combination including the use of a hard stop within their ePOLST systems protocols, the Oregon POLST Coalition has updated its guidance in the POLST® Guidebook for Health Care Professionals on page 11.
Most POLST Forms are Completed during Outpatient Care
Dr. DeVoe’s Sept 28, 2020 article, The Incompatibility of Patient-Centered Care with Fee-for-Service Payment, shares a patient story that highlights the important role of primary care in POLST completion. The article identifies barriers inherent within the payment system.

A recent article in NEJM Catalyst about the growth of eMOLST use in New York reminds us that few POLST forms are completed in the hospital. Only 6% of MOLST forms were completed on hospitalized patients.
The Frequency of POLST "Yes" to CPR is Rising, Again
Graph showing count of POLST forms to age at completion for attempt CPR.
The rate of “yes” to CPR statewide is rising once again in recent submissions to the Oregon POLST Registry. There is a sharp increase in POLST orders for "yes" to CPR at age 65, raising the suspicion of a new ACP incentive at age 65.
The Oregon POLST Coalition is Encouraged by the National POLST Paradigm Policy of Not Incentivizing the Completion of POLST Forms
Photo of hands holding an Oregon POLST
In June of 2018, The Oregon POLST Coalition approved a Policy Recommendation for Quality Measures and expressly stated, "Completion of a POLST form should not be counted as a quality measure."

The National POLST Paradigm Office has recently reaffirmed concerns about the adverse impact of incentives on voluntariness. They succinctly expressed in their Appropriate POLST Form Use Policy, "Fundamentally, POLST is not a form: it is a process."
In addition to concerns about voluntariness, counting POLST forms, even without financial incentives, promotes inappropriate POLST use in healthy 65+ year olds.

More on this topic:
New Video Resource for Care Conversations
Middle-aged man in wheelchair looking outside through window.
The OHSU Center for Ethics in Health Care recently produced a five-minute video to reinforce the vital importance of seeing a person with disabilities as a person first and a diagnosis second. Ian’s story serves as a powerful reminder of the importance of Caring For the Whole Person With Physical Disabilities in the face of a serious illness. Building relationships of caring and trust, significantly enhances later conversations that involve giving bad news and exploring goals for care and treatment.
The Oregon POLST Program wishes you and those you serve to remain well & safe during this challenging holiday season.
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Anthony Antoville, BFA, CMC
Executive Director, Oregon POLST Program
OHSU - Center for Ethics in Health Care
3181 SW Sam Jackson Park Rd, UHN-86
Portland, OR 97239
Copyright © 2020 OHSU Center for Ethics & Oregon POLST Coalition. All rights reserved.

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