Polst

[Ariana30]

Hello, I apologize for this question but I need some clarification. I worked at snf just recently and I'm a lil confused with Polst. First of all, we have a hospice patient that just got in to the unit from the hospital. When I got the report from the hospital, I was told that patient is DNR with signed polst. But when the patient got in to our facility, the Polst wasn't not signed by the physician but signed by the family member. I was told by the supervisor that patient is still DNR because he's hospice and family agreed eventhough the polst wasn't signed by ordering provider. Is it like that? My understanding is,  Polst is only valid if it's completely signed and it doesn't matter if hospice or not. Thank you.

[Been there,done that, ASN, RN]

Is the patient verbal? Have you discussed their wishes? POLST requires the  patient's provider to sign. Request a care conference, in order to carry out the patient's wishes.

[nursej22, MSN, RN]

POLST stands for Physicians Order for Life Saving Treatment, at least in my state. If it's not signed, its not valid. But I think hospice requires a physician order, so I would look to see what the details are on that. 

I would definitely get clarification rather relying on other peoples' word. 

[Daisy4RN]

The POLST is a MD order (vs an advance directive) and therefore needs an MD/provider signature to be a valid order (at least in my state). Check your state requirements and notify the MD immediately for a signature; the pt status  on Hospice doesn’t mean the pt is DNR without an order (ie a signed polst) 

[kbrn2002, ADN, RN]

It's not uncommon at all for paperwork from one agency to not be transferred to another with the patient. As this resident is enrolled in Hospice odds are there is a signed POLST, your facility just doesn't have it. That being said you do need a signed copy in your facility. First ask Hospice if they have a POLST on file and could they forward it to your facility, if that is not  acceptable for your facility then have your rounding provider sign the form you have.  I am assuming the family member that signed it is the responsible party for the resident, as long as that is the case it shouldn't be difficult to get the provider to sign the order.

[CAHP90]

Hello, this is actually pretty common. 

If the patient came from the hospital they have their own POLST and e-order on file for DNR. You can ask for a copy if family signs a medical release form. 

 

Hospice has to get their own consents signed which includes their POLST and this is to be discussed with family again. Because the reps are on the field usually they get everything signed and scan or email it to the office who then faxes it to the Hospice MD/attending physician which is why there is no signature. Later they send that copy to the SNF. Ideally, the SNF should get this during the same day of admission but I've worked for hospice before and sometimes they can take up to 48 hours. So the physical form itself is not valid since the MD is not present during the consents getting signed.  Which is why the RN doing the initial assessment has to write all medication and code status in the SNFs MAR via verbal order and include the MD following the pt into hospice. 

The patient if is under hospice they need to sign all consents themselves if they alert and oriented if not POA can sign for pt. 

? Hope this helps 

 

[delrionurse]

On 3/8/2022 at 1:11 PM, Been there,done that said:

Is the patient verbal? Have you discussed their wishes?

Does that really matter? It's all about the family and what they want these days. By the time hospice rolls around, the patient is not verbal. At least in my neck of the woods.