POLST AND CORONAVIRUS

By Susan W. Tolle MD, Chair of the Oregon POLST Coalition

It is very important for anyone who has Portable Orders for Life-Sustaining Treatment (POLST) to be sure that the orders on your POLST form match your wishes for care and treatment if you get sick during the coronavirus emergency.



Now is the time to look at your POLST and let your health care team and loved ones know if you want to make any changes. We have created a video POLST and Coronavirus: If You Get Sick Do Your Orders Match Your Wishes to help you do this, and this article outlines the main points.



POLST is meant for people who are seriously ill or frail, and not for healthy people. (If you are not frail or seriously ill, you should not have a POLST. An advance directive is a better way for you to share your wishes.)

The orders on your POLST could become very important during this crisis because people who are seriously ill or frail are at higher risk of dying if they get sick with the coronavirus.



Some people choose POLST orders for DO NOT RESUSCITATEand ‘Comfort Measures Only.’ They want to be comfortable and prevent suffering if they are critically ill. This allows death to happen naturally. They will be given medications and other measures to be comfortable. They may wish to stay at home rather than come to the hospital. This choice means that they will avoid intensive care or treatment with a ventilator to breathe for them.



Other people choose DO NOT RESUSCITATEon their POLST orders but they do want some treatments. They are saying ‘yes’ to being in the hospital for basic medical treatments such as fluids by vein or antibiotics. Most people who choose this want to avoid intensive care and do not want a ventilator to breathe for them if they become seriously ill.



People who choose CPR Resuscitationand ‘Full Treatment’on their POLST, will have all available treatments. This includes intensive care and a machine if you cannot breathe on your own.



It is important to know that if you do not have orders to limit the medical treatment you want, you will get every medical treatment available.



If you do not have a POLST and now want one, you will need to call your doctor’s office to complete a POLST form. Your form can be completed by phone and then your wishes for care will become medical orders.



If you already have a POLST and your wishes have now changed—if you decide you no longer want intensive care, or you now want to add intensive care—you need to call your health care team to ask for new POLST orders. The orders will be written to match the wishes you have now. It is also very important to tell your loved ones about what care you want if you become very ill and cannot speak for yourself.



When you write a new POLST, the old one is automatically canceled. But if you decide that you no longer want to have a POLST, you need to contact your health care team and the Oregon POLST Registry at (877) 367-7657to have your POLST removed.



During the coronavirus emergency, it’s possible that there will not always be enough intensive care beds and breathing machines for everyone. If this happens and your POLST orders say that you want CPR and Full Treatment, including intensive care, the health care team will work hard to get the treatment you need and will always provide comfort care.



We hope that you and your family will stay well during the coronavirus emergency. But we know that in times like these the future is uncertain.



It helps to be prepared. First you want to be sure that your POLST orders match your current wishes for the care you want. Then you need to let your health care team and your loved ones know what your wishes are if you were to get very sick.



Planning ahead will give you and those you love peace of mind during this challenging time.



For additional information about the POLST program please visit www.oregonpolst.org