Improving POLST Utilization for Seriously Ill Patients at a Tertiary Care, Academic Oncologic Hospital (TH371B)

Abstract

•Describe the barriers to implementation of the POLST paradigm.•Describe initial first steps at their own institutions to improve POLST documentation for critically ill oncology patients at a tertiary cancer center. Oncologic patients go through multiple heath care transitions at the end of life. Often, goals of care discussions are initiated but communication of the conversation across settings is challenging. The Physician Orders for Life Sustaining Treatment (POLST) offers the means to successfully communicate patient's preferences across care settings. We sought to improve the usage of the POLST for oncologic patients admitted to various oncologic units at a tertiary cancer center, specifically for patients who reported their preferences for end of life care to be No CPR (DNR). In our first PDSA cycle we conducted a survey of the oncologic Advance Practice Providers (APPs) regarding barriers to POLST completion. They reported lack of familiarity with the POLST, not completing the POLST at the time of the initial conversation and forgetting to do it before discharge. Based on this, we completed a brief education on how to complete the POLST. We also made POLST forms readily accessible for all staff. At the end of the first cycle, POLST completion rates increased from 23% to 32%. As part of our second cycle, we attempted to create reminders to encourage the APPs to complete POLSTs for DNR patients. We sent biweekly patient specific emails to the APPs identifying all the patients who were DNR. However, POLST completion rates did not increase. As part of the third cycle, we again brainstormed with the APPs about continued barriers; their biggest limitations were not knowing patient's preferences regarding other components of the POLST and having to pick up the conversation from another provider. We developed a brief communication tool to utilize the information they had to complete part of the POLST and leave the rest blank. After the last PDSA cycle, the POLST completion rates increased to 46%. Increasing POLST documentation is a multipronged approach utilizing education, frequent reminders and ongoing feedback.