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Provider's Orders for Life Sustaining Treatment

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Provider's Orders for Life Sustaining Treatment, Do-Not-Reuscitate, DNR, POLST, Do Not Attempt Resuscitation, DNAR

  • Types
  • Do Not Resuscitate (DNR) or Do Not Attempt Resuscitation (DNAR)
  1. Order prohibits Cardiopulmonary Resuscitation (CPR)
    1. Includes Do-Not-Intubate (DNI)
    2. Implementation varies by state (e.g. DNR as outpatient)
    3. Independent of Advance Directive
  2. Do Not Attempt Resuscitation (DNAR)
    1. Reflects the significant likelihood that Resuscitation will fail (for ROSC or survival to discharge)
  • Types
  • Provider's Orders for Life Sustaining Treatment (POLST)
  1. Background
    1. Initially created in Oregon (1991), and has now expanded to 42 states as of 2018
  2. Indications
    1. Patients in Nursing Homes, Assisted Living, and Life Expectancy <12-24 months
  3. Description
    1. Single page portable doument that transfers between care systems
    2. Unlike abstract Advanced Directives, POLST is composed of actionable orders related to end of life
    3. Addresses multiple medical interventions (DNR/DNI, comfort care, antibiotics, nutrition)
    4. Form travels with patient and copies sent to EMR, EMS, facilities and family
  • References
  1. Olson (2010) Park Nicollet Primary Care Update CME, Minneapolis, MN
  2. Orman and Abbott in Herbert (2018) EM:Rap 18(2): 13-4