Quality of Physician Orders for Life-Sustaining Treatment Forms Completed in Nursing Homes.

Abstract

The physician orders for life-sustaining treatment (POLST) form allows seriously ill individuals to express their preferences for end-of-life treatments. Despite increased POLST use, little is known about the quality of completed forms. We examined the quality of POLST forms prepared for nursing home residents, including whether they had required signatures and clinically consistent care preferences. We conducted a chart review of POLST forms for a sample of nursing home residents in California. We completed POLST audits for 938 residents in 13 nursing homes in Los Angeles. We recorded whether POLST forms were signed by both the patient (or proxy) and the physician, and whether the patient's treatment choices regarding resuscitation and medical intervention were consistent, as required by the California form. Overall, 69.6% of audited POLST forms had at least one indicator of poor quality. Most lacked a required signature (15.8% lacked a physician signature and 17.4% lacked a patient/proxy signature) and 5.6% had conflicting treatment preferences. We found 30.4% of POLST forms for nursing home residents were not complete or documented clinically contradictory treatment preferences. Improvement in the quality of POLST forms is needed.