Increasing Awareness and Recognition of Pediatric Physician Orders for Life-Sustaining Treatment (POLST) at an Academic Children’s Hospital: A Quality Improvement Project (QI708)

Abstract

1.Describe the barriers to POLST recognition and subsequent ordering of correct code status on admission in the pediatric setting.2.Identify possible strategies to increase documentation of POLST awareness and ordering of correct code status on admission in the pediatric setting. When children are admitted to our institution using electronic admission orders, code status defaults to “full code.” POLST documents on file are often not recognized by the admitting team. As a result, there are instances in which code status is incorrectly ordered on admission. Increase documentation indicating POLST recognition by 5% and decrease inaccurate code status orders in EMR by 5% within 1 year. Pre-data was collected via chart review of patients on the Palliative Care Registry in Epic admitted within a two-month window. Documentation of the existence of POLST and whether the ordered code status was consistent with the POLST form was assessed. Intervention included adding a banner in Epic notifying admitting physicians of a POLST, with a corresponding hyperlink to POLST document. Post-data was collected by chart review of patients on the Palliative Care Registry admitted within a two-month window after intervention was implemented. Pre-intervention, 9% of available POLSTs were documented as recognized on admission. Three patients (11%) had incorrect code status ordered on admission. After intervention implementation, 12% of POLSTs were documented as recognized on admission. One patient (5%) had the wrong code status entered by the resident. This was recognized and corrected by the attending within several hours. After implementation of the POLST banner, there were less instances of the wrong code status being entered on admission, thus meeting smart aim of decreasing inaccurate code status orders. However, documentation of reviewing POLST remains low. We feel this may be secondary to the fact that the majority of POLSTs are filled out as full code, and banner alone may not be enough to trigger documentation. One future aim for this project includes adding a line to the standard admission H&P template indicating if POLST is present and reviewed by primary team.