Background: Nationally, extensive gaps have been identified in the patient wishes for end-of-life care and the actual treatment interventions ordered by physicians. Advance directives are leaving families with difficult decisions to make when translating the patient’s end of life wishes. The physician order for life sustaining treatment (POLST) form more succinctly describes the patient’s wishes and is associated with decreased use of unwanted life sustaining treatments that often lead to increased patient pain, prolongation of suffering and increased cost of care. The POLST is a directive with the authority of a physician’s order that clearly spells out the patient’s care and treatment wishes. It was designed for patients with progressive chronic illness, frailty or advanced age with a life expectancy of 12 months or less. Local Significance: Patients in the critical care unit were receiving futile cares and medical interventions not consistent with their wishes. Few patients had documentation of their wishes. Evidence-Based Practice Framework and Change Model: The June Larrabee Model for Evidence-Based Practice Change was used as a framework for the practice change. Kotter’s Change Management Model was used as a theoretical model for guiding the organizational change. Methods: Palliative Care Nurse Practitioners (PC NP) used the surprise question, that of “would you be surprised if the patient were to die within the next 12 months” to decide upon inclusion for patients. The POLST form was utilized to guide advance care planning discussions and document of the patient’s end of life wishes. Objectives and Outcomes: Short term objectives included obtain input from key stakeholders, locate and analyze the best evidence, define the patient population, develop and present and education program, collect baseline data on the current use of the POLST and pilot the use of the POLST. Long term objectives included implement the POLST, create a forum to debrief, spread the project throughout the medical center while celebrating the successes, and disseminate the findings. Outcome measures included increased use of the POLST with increased consistency between the POLST and the physician’s orders for resuscitation resulting in a reduction of invasive procedures and improved quality of care at end-of-life. Results: Patients admitted with a POLST form increased from three percent to 15.9% during the implementation phase. Use of POLST form within the project site increased from zero percent to 52% of patients who meet criteria post implementation. Consistency between physician’s orders for cardio/pulmonary resuscitation and patient’s wishes was 85% after implementation. Conclusion and Recommendation: Success was realized for increased use of the POLST. Spread of the POLST to the integrated delivery system and to the local skilled nursing facilities must occur for sustainment. In addition, an important next step is to lobby for legislative support to have nurse practitioners sign the POLST form, as currently only a physician may sign.
