POLST
Physician Orders for Life-Sustaining Treatment — a portable, actionable medical order (not merely an advance directive) that travels with a seriously ill patient across care settings.
POLST (Physician Orders for Life-Sustaining Treatment) — called MOLST, MOST, or POST in some states — is a brightly colored, standardized form (typically bright pink) that translates a patient's end-of-life wishes into actual physician orders that are immediately actionable across all care settings: hospital, SNF, hospice, home, and in the hands of EMS. It is specifically designed for seriously ill individuals with a life expectancy under 1–2 years or frail elderly individuals for whom the time frame is uncertain.
A POLST form typically covers three critical decisions: (1) CPR preference (attempt resuscitation or DNR), (2) medical interventions scope (full treatment, limited interventions such as IV fluids but no ventilator, or comfort-focused measures only), and (3) artificial nutrition preference (long-term tube feeding, trial period, or no artificial nutrition). The form is signed by both the physician and patient (or surrogate).
The POLST is particularly valuable because standard advance directives are often too vague to provide clear direction in an emergency and may not be immediately available. A POLST posted on the refrigerator or in the medical record gives EMS and emergency staff specific, signed physician orders within seconds. Unlike a DNR (which only addresses resuscitation), POLST covers the full spectrum of end-of-life medical intervention preferences.
Real-World Example
When EMS was called to a 91-year-old's apartment after she collapsed, they found a POLST on her refrigerator indicating "comfort measures only" and "DNR"; rather than beginning aggressive resuscitation, they provided comfort care on scene and transported her to hospice — consistent with wishes she had documented with her physician 4 months earlier.