Use of the physician orders for life-sustaining treatment program in Oregon nursing facilities: Beyond resuscitation status

Susan E. Hickman, Susan W. Tolle, Kenneth Brummel-Smith, Margaret Murphy Carley

Research output: Contribution to journalReview article

84 Citations (Scopus)

Abstract

OBJECTIVES: 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. DESIGN: Telephone survey; on-site POLST form review. SETTING: Oregon nursing facilities. PARTICIPANTS: 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. MEASUREMENTS: A telephone survey; onsite POLST form reviews. RESULTS: 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 (≥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. CONCLUSION: 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.

Original languageEnglish (US)
Pages (from-to)1424-1429
Number of pages6
JournalJournal of the American Geriatrics Society
Volume52
Issue number9
DOIs
StatePublished - Sep 1 2004

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Resuscitation
Nursing
Physicians
Therapeutics
Telephone
Resuscitation Orders

Keywords

  • Elderly
  • End-of-life treatments
  • Ethics
  • Nursing facilities
  • Out-of-hospital DNR

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Use of the physician orders for life-sustaining treatment program in Oregon nursing facilities : Beyond resuscitation status. / Hickman, Susan E.; Tolle, Susan W.; Brummel-Smith, Kenneth; Carley, Margaret Murphy.

In: Journal of the American Geriatrics Society, Vol. 52, No. 9, 01.09.2004, p. 1424-1429.

Research output: Contribution to journalReview article

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abstract = "OBJECTIVES: 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. DESIGN: Telephone survey; on-site POLST form review. SETTING: Oregon nursing facilities. PARTICIPANTS: 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. MEASUREMENTS: A telephone survey; onsite POLST form reviews. RESULTS: 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 (≥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. CONCLUSION: 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.",
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