Some states have developed quick ways to make sure patient wishes are known by all health care providers who are treating them, or who may treat them, such as emergency medical services (EMS) crews. Among strategies being used in various areas are:
Many organizations are working to make sure patient wishes are known and accessible. The project in La Crosse, Wisconsin, described above, is one example of such an endeavor. Three other projects, one involving a physician order, one entailing community-wide education, and one featuring a simplified planning document, have also been successful.Oregon's Physician Orders for Life-Sustaining Treatment (POLST)
Oregon uses the POLST document, developed by a multidisciplinary task force of the Center for Ethics in Health Care at Oregon Health Sciences University with representatives from across the state, to help health care providers honor patients' treatment wishes. The POLST document underwent revisions after extensive pilot testing. Printed on shocking pink card stock, the one-page document is attached to the front of medical records in hospitals and nursing homes. Individuals living at home are encouraged to post the form in a prominent place where any EMS personnel who come to the patient's aid can see it. The POLST was originally designed to resolve problems in respecting DNR orders when patients were transferred from nursing homes to hospitals and was intended to prevent unwanted transfers or hospitalizations. Chapter 7 features more information about the usefulness of the POLST document (Tolle et al., 1998).Georgia Health Decisions
Critical Conditions: Make Your Final Health Care Decisions is the slogan developed by Atlanta-based Georgia Health Decisions (GHD) to encourage Georgians to participate in meaningful advance care planning with families and health care providers. Following a pilot project in eight communities, the program will eventually be used statewide for intense public education and end-of-life planning. "We learned one thing in Georgia, based on focus groups," said Beverly Tyler, executive director. "People have a false sense that they innately know what loved ones would want. In fact, unless they have been through a serious illness, people think the only decision to be made is whether to pull the plug or not."Florida Commission on Aging with Dignity and "Five Wishes"
Thanks to efforts by the Florida Commission on Aging with Dignity, any adult can use a booklet titled "Five Wishes" to guide his or her thinking about how they want to be treated, should they have a life-threatening illness or become unable to voice their decisions. The booklet provides an easy way to record one's wishes. It meets all the requirements of the law in 33 states and the District of Columbia. In one year, more than 250,000 Floridians received copies; within a few weeks of its release on the Web, it was downloaded more than 15,000 times. The final version improves upon the usual legal language of living wills by encouraging comments on the many ways in which a person might choose to be treated. Subjects covered include:
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This online version of the book Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians is provided with permission of Americans for Better Care of the Dying [ www.abcd-caring.org ] and Oxford University Press. All rights reserved.
For further information on quality improvement in end-of-life care visit The Palliative Care Policy Center [ www.medicaring.org ].