Resuscitation. 2014 Jan 6. pii: S0300-9572(13)00930-1. doi: 10.1016/j.resuscitation.2013.11.027. [Epub ahead of print]

Physician Orders for Life-Sustaining Treatment (POLST): Lessons Learned from Analysis of the Oregon POLST Registry.

Schmidt TA1, Zive D2, Fromme EK3, Cook JN4, Tolle SW5.

Author information

• 1Department of Emergency Medicine, Oregon Health & Science University. Electronic address: schmidtt@ohsu.edu.
• 2Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University.
• 3Division of Hematology & Medical Oncology, Oregon Health & Science University.
• 4Department of Emergency Medicine, Oregon Health & Science University.
• 5Center for Ethics in Health Care, Division of General Internal Medicine and Geriatrics, Oregon Health & Science University.

Abstract

BACKGROUND:

Physician Orders for Life-Sustaining Treatment (POLST) has become a common means of documenting patient treatment preferences. In addition to orders either for Attempt Resuscitation or Do Not Attempt Resuscitation, for patients not in cardiopulmonary arrest, POLST provides three levels of treatment: Full Treatment, Limited Interventions, Comfort Measures Only. Oregon has an electronic registry for POLST forms completed in the state. We used registry data to examine the different combinations of treatment orders.

METHODS AND RESULTS:

We analyzed data from forms signed and entered into the Oregon POLST Registry in 2012. The analysis included 31,294 POLST forms. The mean Registrant age was 76.7 years. 21,396 (68.4%) had Do Not Attempt Resuscitation (DNR) orders and 9,900 (31.6%) had orders for "Attempt Resuscitation". The 6 order combinations were: Do Not Resuscitate (DNR)/Comfort Measures Only 10,769 (34.4%), DNR/Limited Interventions 9,306 (29.7%), DNR/Full Treatment 1,211 (3.9%), Attempt Cardiopulmonary Resuscitation (CPR)/Comfort Measures Only 11 (0.04%), Attempt CPR/Limited Interventions 2,281 (7.3%), Attempt CPR/Full Treatment 7,473 (23.9%).

CONCLUSIONS:

The most common order combinations were DNR/Comfort Measures Only, DNR/Limited Interventions and Attempt Resuscitation/Full Treatment. These three make sense to health professionals. However, other order combinations that require interpretation at the time of a crisis were completed for about 10% of Registrants. These combinations need further investigation.