Illinois is unique in that our POLST form has evolved from previous versions of out-of-hospital do not resuscitate (DNR) order forms. The POLST form offers patients and providers more options and more concrete guidance. The Illinois Department of Public Health (IDPH) Uniform DNR Advance Directive allows individuals to outline what their wishes are in case of medical emergencies to direct the medical care they are given, be it by paramedics, physicians, hospitals and/or nursing homes.
In 2000 – The original Illinois Department of Public Health (IDPH) orange DNR form was initiated by Illinois Emergency Medical Services (EMS) leadership, in order to allow for a uniform and understandable instruction to first responders to cardiac arrests in the field. Subsequent legislation instructed IDPH to develop an “IDPH Uniform DNR Order Form” which would account for use by other providers and replace the original “orange form”. IDPH convened an interdisciplinary task force that developed the “IDPH Uniform DNR Order Form” which was released for use in June, 2005. Subsequent legislative changes have included a title change, to “IDPH Uniform DNR Advance Directive” (2006), as well as a decrease of the witnessing requirement from two individuals to one (2010).
From 2006 to 2009, the Retirement Research Foundation provided funding for the Someone to Trust (STT) Advance Care Planning initiative. During this time, STT formed a coalition of Chicago-area hospitals, hospices, nursing homes, healthcare organizations (Metropolitan Chicago Healthcare Council, Institute of Medicine of Chicago, IL Attorney General’s office, Chicago Department of Public Health, Illinois State Medical Society and others), and advocacy groups (Chicago End-of-Life Care Coalition [CECC] and others) to support a local program to promote education on and effective use of advance directives and advance care planning.
In 2007 the Metropolitan Chicago Healthcare Council served as convener of a working group of area physicians, ethicists, EMS representatives and others to draft a revision of the Illinois Uniform DNR form based on feedback that identified the current form as a barrier to honoring patient wishes for life-sustaining treatment. The taskforce included representatives from the IDPH, EMS, ISMS, Illinois Hospital Association (IHA), CECC, STT, several hospital ethicists, chaplains, and practicing physicians and nurses. After numerous meetings and revised drafts, the group was unable to reach consensus on a draft that addressed the concerns of multiple parties, and the process was paused.
In 2010 participants in earlier efforts on the Illinois Uniform DNR form, STT and other stakeholders were invited to a local meeting with Susan Tolle, MD, the developer of the original POLST program in Oregon as well as a founder of the National POLST Initiative. In February 2011, in an effort to facilitate the POLST process, HB 3134 was brought to the state legislature by Representative Sarah Feigenholz, and co-sponsored by Representative Robyn Gabel, who had attended the November meeting. The bill stipulates that the IDPH Uniform DNR Advance Directive form “shall meet the minimum requirements to nationally be considered a Physician Orders for Life-Sustaining Treatment [POLST] form”. It passed through both chambers unanimously and was signed by the governor in August 2011, enrolled as PA-97-0382, effective January 1, 2012.
In January of 2012, a leadership recruitment meeting was held at UIC Hospital, sponsored by The Retirement Research Foundation. Participants where 70 individuals from across the state, representing nearly 60 different organizations ranging from healthcare institutions to regulatory entities to community and professional organization and trade groups. From that meeting, a provisional organizational structure was developed, which included a POLST Illinois Task Force consisting of members from across the state, including physicians, nurses, chaplains, clinical ethicists, attorneys, case managers, and emergency medical personnel. Task Force members represent hospitals/the state hospital organization, hospices/ the state hospice organization, the state medical society, medical systems, faith organizations, EMS, trade organizations (long term care, end-of-life/palliative care, nursing) and others.
On March 14, 2013, the Illinois Department of Public Health released a revised version of its “IDPH Uniform Do-Not-Resuscitate(DNR) Advance Directive”. The updated form represents adoption in Illinois of a widely recognized best practice (Physician Orders for Life-Sustaining Treatment or POLST) that documents medical orders for life-extending treatments for seriously ill patients. The new document, while visually similar to the old version, is different in important ways. Healthcare providers and first responders need to be aware of these differences in emergency situations.
On January 1, 2015, the Illinois Department of Public Health will publish a revision of the out-of-hospital “IDPH Uniform DNR Advance Directive/Physician Orders for Life-Sustaining Treatment” form. Old versions of the form will continue to be honored, but clinicians should use the revised form effective 1/1/2015. Changes to the form include:
- TITLE: The title of the form has been changed to “IDPH Uniform DNR/POLST Form”, where POLST now stands for Practitioner Orders for Life-Sustaining Treatment.
- FORM IS VOLUNTARY: Addition of language stressing that this form cannot be required of any patient, and is completely voluntary.
- SECTION A: The CPR and DNR options are now on a single line to avoid the possibility of checking the wrong box.
- SECTIONS B AND C: Language for the titles and description of treatment plans have been changed. While the three treatment plan levels are conceptually unchanged, some of the language has been altered to allow the form to be more easily understood by both patients and clinicians. The listing order of the options follows the same concept as in Section A, with the most medically invasive treatment plan being listed first, and less invasive following.
- ADDITIONAL PRACTITIONERS: With the new form, additional practitioners will be able to sign the POLST orders. In addition to attending physicians, others who can sign the form are: Advance Practice Nurses (APN’s), Physician Assistants (PA’s), and licensed medical residents who are in their second year or above of training. These additions are reflected in Section E of the form.
The goal of the POLST Taskforce is to maximize patients’ control of their medical care by helping them establish a care plan that aligns with their own treatment wishes with what is medically realistic, and to document these wishes in a uniform, secure and retrievable document that can be used to direct medical care in a variety of settings. The Illinois POLST form is one means of establishing that care plan.