Hawai'i State Center for Nursing celebrates legislation expanding POLST

University of Hawaiʻi at Mānoa
Wendy Suetsugu , (808) 956-0524
Executive Director, Hawai`i State Center for Nursing
Posted: Jul 2, 2014

Older people are encouraged to document their wishes for end-of-life medical decisions and nationally about 73% have completed such advance directives or living wills. In the face of acute or serious chronic illness, advance directives have little effect on whether people are hospitalized or if their wishes are followed. To address this need, the Physician Orders for Life Sustaining Treatment (POLST) emerged to complement the advance directive for those with a serious illness at any age.  Following discussion with the patient to ensure the patient’s wishes for care are being accurately represented, the form is completed by the health care provider. It provides orders for current medical treatment and when shared, is available to emergency medical personnel. When the POLST is signed, the wishes of the patient are made clear to the healthcare team treating the patient.  The POLST has benefits for family and loved ones of the patient since the patient’s wishes are clearly described.  This can eliminate the burden of  loved ones faced with the often difficult decision to determine care of a seriously ill loved one or one who is reaching end of life.

Governor Neil Abercrombie on Monday, June 30, signed a bill into law that expands health care provider signatory authority for POLST to include Advanced Practice Registered Nurses (APRNs).  The bill language updates references from “physician orders for life-sustaining treatment” to “provider orders for life-sustaining treatment” (POLST).

By expanding the signatory authority to include APRNs, the bill allows for patients to continue to have access to completing these orders when the APRN is the care provider and a physician is unavailable for consultation. APRNs in Hawaiʻi are increasingly designated as the primary care provider and are educated to begin such conversations with their patients and families.

“This bill will improve access for patients, or their legal representative, with serious illness to complete the Providers Orders for Life Sustaining Treatment without undue delay.  Many organizations and physicians often turn to the APRN to assist the family’s processing of these important decisions about health care options in their final chapters of life.  This is done in collaboration with physicians, but it is very often the APRN that is on site to meet with the patient, family and other members of the health care team, and complete the documents,” said Valisa Saunders MN, APRN, GNP, Instructor at the University of Hawai’I at Mānoa School of Nursing and Dental Hygiene and Nurse Practitioner with Leahi and Maluhia Hospitals, Hawaiʻi Health Systems Corporation.

For copies of the POLST form, handouts for providers and consumers, or information on advance directives please contact Kokua Mau, Hawaiʻi's Hospice and Palliative Care Program at www.kokuamau.org