A law passed by the 2013 General Assembly offers you a new tool to use in caring for patients with terminal or advanced chronic progressive conditions.
HB 1182 Physician Orders for Scope of Treatment (POST) is based on programs in use or development in more than 40 states. It facilitates identification and implementation of patient treatment preferences near the end of life and is a preferred practice in palliative care – to improve quality and continuity of care.
The POST form is available on the Indiana State Department of Health (ISDH) website at www.ismanet.org/go/POST120913 in the Forms section. It is appropriate if the answer is NO to the question: Would I be surprised if this patient died within the next 12 months?
As our aging population faces a greater disease burden from chronic illnesses, conversations between patients and physicians about prognosis and treatment become more critical. POST is uniquely designed to document the goals of care for patients most likely to experience diminished benefit and increased burden from usual treatment options or full intervention.
The two-page state-recognized POST form, to be completed in consultation between patient and physician, allows:
- Patients with serious chronic illnesses to clarify exact wishes about specific medical treatments based on current health status, and to designate a health care representative
- Physicians to convert treatment preferences into immediately actionable medical orders regarding code status, level of medical intervention, antibiotics and nutrition
- Health care systems to have a single document that applies across all health care settings – home, hospital, long-term care facility, emergency department and more
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The following questions and answers were developed by Susan Hickman, Ph.D., co-chair, Indiana Patient Preferences Coalition, and Sarah Tieman, M.D., Palliative Care Team, IU Health Bloomington. (Reprinted with permission from the authors and the Monroe/Owen County Medical Society Newsletter.)
Which patients can use a POST form?
Patients must have one or more of the following:
- A terminal condition
- An advanced chronic progressive illness
- Advanced chronic progressive frailty (Note: Frailty is a medical diagnosis.)
- Low likelihood of benefiting from CPR
Who can complete a POST form?
The form, which must be signed by the patient or his/her legally authorized representative, should be completed by the physician or a designee named by the physician. It requires the physician’s signature to execute the order – in addition to the physician’s license number, address and phone number.
What does POST cover?
The POST form covers:
- Code status
- Level of medical intervention
- - Comfort measures (allow natural death); transfer only if comfort needs cannot be met at current location
- - Limited additional interventions: hydration, monitoring, non-invasive ventilation, transfer
- - Full intervention: ICU care, invasive ventilation
- Use of antibiotics
- Use of medically administered nutrition
- Designation of health care representative
How does POST work in the hospital setting?
POST is valid in ALL settings including the emergency department. Note that:
- Admission orders should be consistent with POST orders.
- POST orders should be used to guide treatment decisions, including level of aggressiveness of intervention in a hospital.
- Individual hospitals should develop policies and procedures for implementing and tracking POST.
What if the patient lacks decisional capacity?
A POST form can be completed based on a conversation with a/an:
- Appointed health care representative
- Individual’s attorney in fact with authority for consent or refusal of the individual’s health care
- Legally appointed guardian
Decisions must be based on prior-known wishes or best interest of the patient.
Legal fine print
- A POST form signed by a patient (or legal surrogate) and physician is a legal medical order set.
- POST provides legal protection for health care providers who comply with the orders on the Indiana form. Health care providers are not subject to civil or criminal liability for good faith compliance with or reliance upon the Indiana POST form.
- A POST may be revoked at any time – by request of the patient or legal representative – in writing, through oral expression or by physical destruction of the form.
Find more information and education about POST here and here.