During this COVID-19 pandemic, goals of care conversations and POLST forms may be completed without the opportunity to have an in-person conversation. The best practice to obtain consent for a tele-health POLST conversation is to follow an organizational policy that addresses verbal consents and to fully document the conversation in the medical record. Include:
Who was engaged in the conversation, patient or surrogate?
Were family members or others included?
If the patient, was it clear that he/she was capable of understanding the discussion and able to make health care treatment decisions?
When and how is the form being transmitted to location where patient is receiving care?
As soon as possible, the patient or surrogate signature should be obtained.
A health care practitioner's verbal order for a POLST is effective from the date given without countersignature until the expiration of the period of countersignature if all of the following requirements are met:
The order is entered for a patient receiving care from a health care facility.
The order is documented on the POLST form and countersigned by the health care practitioner in accordance with any applicable laws and regulations governing the health care facility, including but not limited to a timeframe in which the order must be countersigned.
No law or regulation governing the health care facility establishes a time limit in which the order must be countersigned, and the order is countersigned by the health care practitioner within seven days.
In a recent edition of POLST Notes various resources relating the pandemic were featured. Another summary of useful resources is found at the National POLST website, https://polst.org/covid/). An AMDA guide at the site, CPR Guidance During the COVID-19 Pandemic advises “Please also consider each patient’s goals of care, long before the need for CPR might arise. Early discussion of advance directives, as well as code status, can help ensure that residents’ goals are met, without creating unnecessary risk and exposure to staff during CPR.”
A completed POLST form aids emergency personnel in implementing patient treatment preferences as communicated to and documented by the patient’s health care professional. For patients with POLST forms who are experiencing symptoms of COVID-19, it is important to determine that their POLST orders reflect their current wishes for care. View the new PA POLST and Coronavirus video for more information.
Oregon POLST Program
In a spirit of sharing, the Oregon POLST Program created a video that notes some of the valuable innovations in POLST policy, procedure and education taking place across that state during the current COVID-19 pandemic. Included is a discussion on how improvement can occur in locating POLST forms in a crisis, screening for POLST in the emergency department and triaging patients in primary care.
The OHSU Center for Ethics in Health Care shares this 11 minute video titled “Moral Distress during a Time of Health Care Crisis: When Following the Rules Doesn’t Fee Right” led by Dr. Tyler Tate, Director of Professionalism and Comfort Care at the OHSU Center for Ethics. He discusses the emotional pain many health care workers are experiencing as they enforce strict visitation policies on families in order to protect both patients and themselves.
Thank you for your continuing support of POLST. For POLST forms and information on the POLST process, go to: