Marilyn Olson, community educator with Frontier Home Health and Hospice, has launched a campaign for a form that expresses a patient’s wishes about life-sustaining treatment.

Olson has found many people, including physicians, are not familiar with its advantages as a complement to the “Five Wishes” and “Comfort-One” forms. Called POLST for Montana Provider Orders for Life-Sustaining Treatment, the form was approved by the Montana Board of Medical Examiners about a year ago.

  The board adopted it to rectify a problem with the Comfort-One form’s resuscitate directions applying only to emergency medical personnel coming to the home. Once a patient reaches the hospital, the Comfort-One form does not apply.

“They wanted to expand the form so it became a provider’s order that follows the patient through the medical system,” Olson said. “The same as ‘Five Wishes,’ the POLST Form also speaks on your behalf.”

As a provider order, it gives clear instructions to all medical personnel from the ER to a nursing home about the level of treatment desired by the patient.

The simple one-page form allows a person to select either “resuscitate” or “do not resuscitate;” medical intervention level as comfort measures, limited added interventions or full treatment with full descriptions of each; types of artificial fluids and nutrition and antibiotics and blood products or one or neither.

Section D of the form asks about additional forms, such as a living will and the Five Wishes, that a patient may have in effect. The final section has the provider’s signature as well as the patient or a surrogate’s signature certifying that the POLST supersedes the living will if the two conflict.

It may be signed by a physician, nurse practitioner or physician’s assistant. Olson has scheduled presentations and hopes to have more with providers to make certain they understand and feel comfortable working with patients to complete the form. 

“This form was initially designed to be discussed with a physician,” Olson said.

She found in personal experience that some physicians get “that deer in the headlights look” when asked to go over the form with a patient. Her mother’s doctor got that look, signed the form, and asked her to go over it with her mother.

“What I want to do is raise awareness with physicians and the community,” she said. “First we need to get the physicians on board. No one should have the ‘deer in the headlights look’ a year later.”

She recommends that people make sure it becomes part of your medical records so any provider can pull it up. Olson also recommendeds that a patient post it in a prominent location such as on the refrigerator, the back of the bedroom door or a bedside table, or in the medicine cabinet.

People in long-term care facilities should have the POLST form in their medical chart along with other medical orders.

According to a brochure, the form is intended for anyone with an advanced, life-limiting illness. However, Olson said anyone 18 or older can have the form as part of his or her medical records.

“Why shouldn’t we have one in place?” she asked. “By the time you go in the hospital, you are in crisis mode. Do it when you’re healthy.”

Olson points out that someone might be involved in auto or other accident where direction is needed. She called it “a proactive way to have your affairs in order.”

Frontier Hospice has the form or  people can download it from polst.mt.gov on the Internet. Physicians or other health-care providers should also be able to provide the form.

Olson invites people to contact her at 755-4923 for a presentation or more information.