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Revised POLST Form – Now Available

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The Illinois Department of Public Health has published a revision of the out-of-hospital emergency treatment form, now called the “IDPH DNR/POLST” form. Old versions of the form will continue to be honored, but clinicians should use the revised form. The Spanish revision has not been released, but will added when it is available.

POLST Illinois emphasizes that the use of the form is part of an extended conversation regarding advance care planning, and the form is NOT for everybody.  It is meant to be discussed with patients for whom death within a year would not be unexpected,  These patients are generally those with advanced, serious illness and the frail elderly.The form is a medical order that must be respected at any location, and may be changed by the patient or their appropriate substitute decision-maker at any time if their condition or preferences change.  The POLST training materials are currently being updated to reflect the form changes, and should be completed by February 2.  Changes to the form include:

  1. TITLE: The title of the form has been changed to “IDPH DNR/POLST Form”, where POLST now stands for Practitioner Orders for Life-Sustaining Treatment.
  2. ADDITIONAL PRACTITIONERS: With the new form, additional practitioners will be able to sign the POLST orders.  In addition to attending physicians, additional clinicians who can now 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.
  3. FORM IS VOLUNTARY:  Language has been added stressing that this form cannot be required of any patient, and is completely voluntary.
  4. SECTION A:  The CPR and DNR options are now on a single line to avoid the possibility of checking the wrong box.
  5. SECTIONS B AND C:  Language for the titles and description of treatment plans have been changed 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.  The following language changes were also made:
  • “Intubation and Mechanical Ventilation” has been changed to “Full Treatment”
  • “Limited Additional Interventions” has been changed to “Selective Treatment”
  • “Comfort Measures Only” has been changed to “Comfort-Focused Treatment”
Author: POLST Illinois

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