Table 2.
Consistency between POLST form orders and relevant treatments provided to nursing facility residents.
| POLST Section | POLST Orders | # receiving elevant treatments |
# not receiving relevant treatments |
# order revoked1 |
# insufficient information2 |
# provided treatments consistent with order |
# provided treatments inconsistent with order |
Provided treatments consistent with order by section |
|
|---|---|---|---|---|---|---|---|---|---|
| Section A: Cardiopulmonary Resuscitation |
Do Not Resuscitate (n = 635) |
Living (n=336) |
0/336 | 336/336 | 0 | NA | NA | NA | 98.0% (300/306) |
| Deceased (n = 299) |
0/299 | 299/2993 | 0 | NA | 299/2993 | 0/0 | |||
| Full Code (n = 106) |
Living (n = 94) |
0/94 | 94/94 | 0 | NA | NA | NA | ||
| Deceased (n = 12) |
1/12 | 11/12 | 54 | NA | 1/7 | 6/7 | |||
| Section B: Medical Interventions |
Comfort Care Only (n=300) |
41/300 | 259/300 | 2 | 4 | 26/35 | 9/35 | 91.1% (102/112) |
|
| Limited Additional Interventions (n=335) |
63/335 | 272/335 | 1 | 4 | 57/58 | 1/58 | |||
| Full Treatment Interventions (n=83) |
19/83 | 64/83 | 0 | NA | 19/19 | 0/19 | |||
| Section C: Antibiotics |
No Antibiotics (n=28) |
9/28 | 19/28 | 2 | NA | 0/7 | 7/7 | 92.9 % (224/241) |
|
| Limited Antibiotics5 (n = 214) |
65/214 | 149/214 | 1 | 4 | 50/60 | 10/60 | |||
| Full Treatment Antibiotics(n = 467) |
174/467 | 293/467 | 0 | NA | 174/174 | 0/174 | |||
| Section D: Artificial Nutrition |
No Feeding Tubes (n = 417) |
4/417 | 413/417 | 0 | 0 | 1/46 | 3/4 | 63.6% (14/22) |
|
| Defined Trial Period (n = 193) |
5/193 | 188/193 | 0 | 0 | 0/5 | 5/5 | |||
| Long-Term (n = 68) |
13/68 | 55/68 | 0 | NA | 13/13 | 0/13 | |||
NA = Not applicable.
Note: Completion of POLST sections B, C, and D is optional and therefore the sample sizes vary by POLST section. Relevant treatments for each specific order are as follows: CPR (Section A); hospitalization/emergency department (ED) visits, ICU care, intubation/ventilator support, intravenous (IV) fluids, dialysis, transfusion, surgery/invasive diagnostic tests, chemotherapy, and radiation (Section B); antibiotics (Section C); and feeding tubes (Section D).
When evidence was found that the POLST order was revoked, the case was removed from the denominator in the calculation of consistency and inconsistency.
Treatments provided to residents with orders permitting treatment in some circumstances but insufficient information to determine the treatment rationale were removed from the denominator.
The absence of CPR is consistent with a DNR order for deceased residents. It was counted as a provided treatment consistent with the orders because the treatment was indicated but not provided.
In all 5 cases, a non-POLST do not resuscitate order was written prior to death but POLST was not revised accordingly, so these were counted as revocations.
Section C orders for limited antibiotics include exceptions allowing for treatments to enhance comfort on the current Wisconsin POLST form and prior versions of the Oregon POLST form.
In one case, treatment was being provided when the POLST order was written. The order specifically stated: “No feeding tube in the future. Has feeding tube; if feeding tube fails, do not reinsert.”