Portable Medical Orders (POLSTs) vs Advance Directives

A POLST is a part of the advance care planning process and communicates your wishes as medical orders. A POLST form consists of a set of medical orders that applies to a limited population of patients, such as seriously ill or frail persons, and addresses a limited number of critical medical decisions. A POLST has the option of specifying Do Not Resuscitate (DNR) but also makes provision for other types of treatment such as feeding tubes and mechanical ventilation. They will be filled out in consultation with your doctor.

POLSTs have different names in different states.

What is a POLST?

A POLST communicates your wishes as medical orders, and so is prepared together with your doctor who will sign it. POLST’s have different names in different states, but all have the force of medical orders. POLST’s are specifically for the seriously ill or frail. POLST’s can travel with you and are honored by emergency medical technicians.

How is a POLST different from an advance directive or DNR (do not resuscitate)?

• POLST = Portable Medical Orders.Different states use different names such as POLST, POST, MOLST, MOST, etc. for their programs.
• POLST is for people who are seriously ill or have advanced frailty. If you are healthy, an advance directive is for you. POLST forms and advance directives are both parts of advance care planning but they are not the same.
• POLST forms must be filled out and signed by health care provider. When you need a prescription, you go to your provider who writes or types an order for your prescription and signs it. POLST is a medical order so it is the same: you need to go to your health care provider who will write out the POLST and sign it. The difference with POLST is that you should have a good talk with your provider about what you want considering your current medical condition: What is likely to happen in the future? Treatment options? You’ll also be asked to sign your POLST form.
• POLST forms tell other providers what you want. During a medical emergency, if you can talk, providers will ask you what you want. POLST forms are used only when you cannot communicate and you need medical care. When that is the situation, the POLST form orders providers to give you the treatments you chose.
• POLST forms are out-of-hospital medical orders. This means that they are medical orders that travel with you. Wherever you are, your POLST form tells health care providers what treatments you want and your goals of care, even if you transfer from hospital to nursing home, back to your home, or to hospice or another setting.
• POLST is voluntary. You make the choice about having a POLST form: you should never be forced to have one! If you are healthy, however, your provider may choose not sign a POLST form for you since it was designed for people who are seriously ill or have advanced frailty (some state laws do not allow providers to sign a POLST form unless you are seriously ill or have advanced frailty).
• Advance Directives: POLST’s give specific directions about treatments during an emergency if you cannot speak for yourself. However, POLSTs do not appoint someone to speak on your behalf (surrogate or health care agent) which Advance Directives generally do. In a POLST, you specify exactly what you want and don’t want and for how long. They have the force of medical orders and must be honored by emergency medical technicians (EMT’s). EMT’s cannot honor advance directives or medical powers of attorney. Once emergency personnel have been called, they must do what is necessary to stabilize a person for transfer to a hospital, both from accident sites and from a home or other facility. After a physician fully evaluates the person’s condition and determines the underlying conditions, advance directives can be implemented.

• Do Not Resuscitate (DNR’s): A do-not-resuscitate order, or DNR order, is a medical order written by a doctor. It instructs healthcare providers not to do cardiopulmonary resuscitation (CPR) if a patient’s breathing stops or if the patient’s heart stops beating. If presented, it will be honored by EMT’s. A POLST has the option of specifying DNR but also makes provision for your choices around resuscitation and other types of treatment such as feeding tubes and mechanical ventilation.

How do you fill out a POLST form?

POLST’s fit into the entire advance care planning process. By the time most people want or need a POLST they will have learned about their condition, thought about their values and quality of life, and had conversations with those close to them. The actual filling out of the POLST usually takes place in your doctor’s office after a good talk about your medical condition, treatment options, and what you want. Your doctor will fill it out and both of you will sign it. It is good to make several copies for yourself and one will be put in your medical record.

How do you find the POLST for your state?

You may want to review your state’s form before you meet with your doctor. The National POLST website has lots of information on POLSTs in general and you will be able to find and review the one from your state.