Response to Clemency et al: Significant Errors, Gaps in MOLST Process, and Opportunities for Improvement With eMOLST

Abstract

We appreciate the interest of Clemency et al and JAMDA in both the National Physician Orders for Life-Sustaining Treatment (POLST) Paradigm and New York's Medical Orders for Life-Sustaining Treatment (MOLST) Program. As we lead the MOLST Program in New York State, we recognize the challenges with paper completion of both the New York MOLST form and POLST Paradigm forms in other states. We also appreciate the authors' attempts to document errors in MOLST completion. Accurate documentation of the errors frequently found in paper completion of New York MOLST forms or POLST Paradigm forms reinforces the need for a standardized approach to end-of-life discussion. Implementations of systems such as eMOLST prevents medical errors by including the clinical process for completion of the medical orders. However, in publishing this article, the authors unfortunately have (1) explained incompatible orders in ways that are not medically accurate and made errors in the standards for reading and following MOLST orders; (2) created misunderstandings about the MOLST process; and (3) failed to recognize potential solutions to the problems they describe, including New York's eMOLST. Decisions by Default: Incomplete and Contradictory MOLST in Emergency CareJournal of the American Medical Directors AssociationVol. 18Issue 1PreviewWhat patients intend when they make health care choices and whether they understand the meaning of orders for life-sustaining treatment forms is not well understood. The purpose of this study was to analyze the directives from a sample of emergency department (ED) patients' MOLST forms. Full-Text PDF The Realities of Operationalizing MOLST Forms in Emergency SituationsJournal of the American Medical Directors AssociationVol. 18Issue 2PreviewThe goal of “Decisions by Default: Incomplete and Contradictory MOLST in Emergency Care” was to provide insight into the unintended consequences that may arise when emergency medicine providers are called upon to interpret and act upon MOLST (New York State's POLST paradigm) forms that are incomplete or contain potential inconsistencies.1 We have been pleased by the overwhelmingly positive feedback we have received since the electronic publication of our article. We hope the article will contribute to a thoughtful, respectful dialogue about the potential implications of incomplete and inconsistent MOLST forms in the emergency setting. Full-Text PDF