Improving Completion Rates of Physician Orders for Life-Sustaining Treatment Forms in an Assisted Living Facility

Background: Advance care plans and living wills are not readily available during emergencies. Physician orders for life-sustaining treatment (POLST) forms are a standardized form that provides orders in emergencies to provide or withhold care.

Local Problem: POLST forms are not being completed upon admission to an assisted living facility (ALF).

Methods: A quality improvement project. Quantitative data included POLST form completion rates, code status selected, and POLST Knowledge survey for staff and resident and/or surrogate decision makers. Qualitative data included questions at the end of the POLST Knowledge Surveys.

Interventions: Licensed practical nurses (LPNs) completed a pre- and post- POLST Knowledge Survey after education on the Respecting Choices® Decision Aids. After education, implementation of Respecting Choices® Decision Aids into POLST conversations occurred with residents and/or surrogate decision makers upon admission to the ALF.

Results: The LPNs did not have a knowledge deficit on POLST forms prior to project implementation. Residents and/or surrogate decision makers lacked understanding of POLST forms. POLST form completion rate remained the same as pre-intervention.

Conclusions: LPNs found the use of Respecting Choices® Decision Aids beneficial to POLST conversations. The POLST Knowledge Survey for Residents and/or surrogate decision makers showed a knowledge deficit related to POLST forms. POLST completion rate can improve closer to 100% since those that received the Respecting Choices® Decision Aids had a POLST completion rate of 100%. Project site to continue utilizing Respecting Choices® Decision Aids.