Pennsylvania POLST (Pennsylvania Orders for Life Sustaining Treatment)

The goal of the POLST paradigm is to effectively communicate the wishes of seriously ill patients to have or to limit medical treatment as they move from one care setting to another. Learn more by visiting the POLST website.

POLST in Action in Pennsylvania Video

Watch POLST in Action in Pennsylvania video.

The Pennsylvania Orders for Life-Sustaining Treatment (POLST) Form

The POLST FORM and brief information on its development and use in Pennsylvania is accessible at the following links.

Users are asked to print copies of the form on pulsar pink card stock (65#). The POLST Wallet Card should be printed on both sides of page.

• Introduction to the POLST Form
• POLST form, English version
• POLST form, Spanish version
• POLST Wallet Card
• Critical POLST Facts
• POLST and the Out of Hospital Do Not Resuscitate Order, Similarities and Differences

For Patients and Families

• POLST Brochure, English version
• POLST Brochure, Spanish version
• Information for Patients and Families
• National POLST Paradigm website

Implementation and Appropriate Use of POLST

• Guidance for Health Care Professionals  
• National POLST Paradigm, “Appropriate POLST Paradigm Form Use Policy"
• National POLST Paradigm, “Intended Population & Guidance for Health Care Professionals”
• POLST Education Powerpoint
• Frequently Asked Questions
• Implementation Checklist
• Milestone Chart
• A Best-Practice Guide for Long-Term Care Providers. Includes:
  • Advance Care Planning (ACP) in Long-Term Care Facilities: Best Practice;
  • POLST Do’s and Don’ts;
  • Patient and Resident Family Form;
  • POLST Preparation Questionnaire
• Quick Start Guide to Health Care Decision-Making

The POLST Conversation

• National POLST Paradigm, “POLST Conversation and Documentation” 
• 8-Step POLST Protocol – A Guide for the POLST Discussion
• Conversation Cue Card
• Helpful Phrases for Conversations 
• Cultural and Spiritual Awareness 
• Conversation Point- Key Information 
• Serious Illness Conversation Guide - Ariadne
• The Second Conversation: How to Talk with a Patient who has a POLST

References and Web Sites

• POLST Paradigm Core Elements
• PA Department of Health Out-of-Hospital Do-Not-Resuscitate (DNR) Orders
• Guidance for Health Care Professionals in Completing the POLST Form
• The Physician Orders For Life Sustaining Treatment (POLST) Coming Soon To A Health Care Community Near You
• Article on POLST published in the Cleveland Clinic Journal of Medicine
• Resources for the Use of POLST

Policy Examples 

• Model Policies' Introduction
• Recommended Policy Elements

Resources

• AARP Public Policy Institute: Improving Advanced Illness Care: The Evolution of State POLST Programs
• Oregon POLST
• West Virginia POLST
• Recommended Book: Hard Choices for Loving People
• National POLST Paradigm 
• National POLST Paradigm Resources

Fast Facts and Concepts

• #16 Moderating an End-of-Life Family Conference
• #23 Discussing DNR Orders—Part I
• #24 Discussing DNR Orders—Part II
• #65 Establishing End-of-Life Goals: The Living Well Interview
• #162 Advance Care Planning in Chronic Illness
• #178 The National POLST Paradigm Initiative
• #360 The Surprise Question as a Prognostic Tool

For More Information

Inquiries on POLST can be directed to: PAPOLST@verizon.net.