The Pearls of Physician Orders for Life Sustaining Treatment (POLST): Translating Patient Decisions into Treatment Orders

Abstract

Since the Physician Orders for Life Sustaining Treatment (POLST) Paradigm began in 1991, POLST has become utilized throughout the United States. POLST includes the national POLST Paradigm as well as state and regional programs and their specific POLST orders. Yet many nurses may not have received the education needed for POLST implementation. This article seeks to honor individual preferences through advance care planning (ACP) by providing an understanding of POLST, which documents individual treatment wishes as medical orders. In the article the authors discuss advance care planning, advance directives, changes in patient status, and the inception and description of POLST. They distinguish POLST from DNR orders, compare POLST to advance directives, and describe the roles of registered and advanced practice nurses. Additionally, they consider studies that have endorsed the POLST paradigm, and share POLST paradigm pearls as well as possible paradigm pitfalls.