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POLST (Physician Orders for Life-Sustaining Treatment) is an approach to improving end-of-life care in the United States, encouraging doctors to speak with patients and create specific medical orders to be honored by health care workers during a medical crisis. POLST began in Oregon in 1991 and is currently promoted in over 26 states through national and statewide initiatives. The POLST document is a standardized, portable, brightly colored single page form which documents a conversation between a doctor and a seriously ill patient or their surrogate decision-maker. It is a medical order; the POLST form is always signed by a doctor and, depending upon the state, the patient. One difference between a POLST form over an advance directive is that the POLST form is designed to be actionable throughout an entire community. It is immediately recognizable and can be used by doctors and first responders (including paramedics, fire departments, police, emergency rooms, hospitals and nursing homes). POLST forms are recommended for all patients with life-limiting illnesses or progressive frailty. A pragmatic rule for initiating a POLST can be if the clinician would not be surprised if the patient were to die within one year. POLST orders are also known by other names: medical orders for life-sustaining treatment (MOLST), medical orders on scope of treatment (MOST), physician's orders on scope of treatment (POST) or transportable physician orders for patient preferences (TPOPP). == What is POLST? == POLST represents a significant paradigm change in advance care policy by standardizing provider communications through a plan of care in a portable way, rather than focusing solely on standardizing patients' communications via advance directives.〔 The POLST paradigm requires providers and patients or their surrogates to accomplish three core tasks: *First, POLST requires a health care professional to initiate a discussion with the patient (or the patient's authorized surrogate) about treatment options in light of the patient's current condition.〔 *Second, the patient's preferences for end-of-life treatments are incorporated into medical orders, which are recorded on a highly visible, standardized form that is kept at the front of the medical record or with the patient if the patient lives in the community.〔 :POLST forms record several treatment decisions common to seriously ill patients: cardiopulmonary resuscitation; the level of medical intervention desired in the event of an emergency (comfort only, limited treatment, or full treatment); and the use of artificial nutrition and hydration. Some states address additional interventions such as antibiotics and mechanical ventilation. As technology and treatment options change, POLST forms will also continue to evolve.〔 *Third, providers encourage that the POLST form travels with the individual whenever he or she moves from one setting to another, thereby promoting the continuity of care throughout a community.〔 :The POLST form is designed to transfer across treatment settings, so it is readily available to medical personal, including EMTs, emergency physicians and nursing staff. The POLST program relies upon teamwork and coordinated systems to ensure preferences are honored throughout the health care system. Research suggests the POLST form accurately represents patient treatment preferences the majority of the time and that the treatments provided at the end of life match the orders on the form. An established POLST program can help reduce unwanted hospitalizations and honor the patient's end-of-life wishes.〔 To determine whether a POLST form should be completed, clinicians should ask themselves, "Would I be surprised if this person died in the next year?" If the answer is that the patient's prognosis is one year or less, then a POLST form is appropriate. In a 2006 consensus report, the National Quality Form observed that "compared with other advance directive programs, POLST more accurately conveys end-of-life preferences and yields higher adherence by medical professionals." The National Quality Forum and other experts have recommended nationwide implementation of the POLST paradigm Implementation of POLST was also recently recommended by the National Academy of Sciences Institute of Medicine in its report, "Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life." The report was released September 17, 2014. 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Physician Orders for Life-Sustaining Treatment」の詳細全文を読む スポンサード リンク
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