The POLST should be reviewed if the patient is transferred from one care setting or care level to another; there’s a substantial change to the patient's health status, or the patient's or decision-maker's treatment preferences change. In POLST, providers may initial the form, indicating that a review has been conducted with no changes required. The RN may explain or review the existing POLST with the patient or surrogate.
Discussions that include the patient, their medical provider, surrogate decision-maker, and key family members should be had regarding the appropriateness of POLST or making significant changes to it. The discussion should review the patient's medical history with recommendations from treating providers and should consider whether the patient has advanced dementia, osteoporosis, bleeding disorder or other conditions and situations in which chest compressions or other cardiopulmonary resuscitation (CPR) interventions may cause more harm than benefit to the patient.
If the patient or surrogate and provider conclude this patient should not receive CPR even in case of choking or other accident, note “Do not Attempt Resuscitation (DNAR) - No Exceptions” in Section A of the POLST. The note should be initialed on the form by a provider authorized to sign the POLST.
Death with Dignity (Aid-in-Dying): Role of the Nurse Advisory Opinion
Washington State Department of Health: Portable Orders for Life Sustaining Treatment (POLST)
Washington State Medical Association: