Integration of Infection Management in Physician Orders for Life-Sustaining Treatment (POLST)

Background: Physician Orders for Life-Sustaining Treatment (POLST) is an Advance Care Planning (ACP) tool which aims to facilitate End-of-Life care decisions between a patient and a medical provider. Understanding and documenting a dying patient's care preferences for specific medical interventions to be implemented at EoL is a critical part in ACP. As infections are common occurrences at the End-of-Life (EoL), assessing patient's care preferences for infection-related medical interventions is an important component of EoL care planning . The aim of this study was to: examine variation in implementation of Physician’s Orders for Life-Sustaining Treatment (POLST) programs across the nation; and, identify associations between POLST programs and three infection-management treatments.

Method: An web-based data collection tool was developed, and the national environmental scan was conducted to assess 1) the status of POLST implementation (i.e,non-conforming, developing, endorsed or mature) using the POLST website; and 2) assessment of infection-management treatments (i.e., antibiotic, IV fluid use, hospital transfer) preferences on each state POLST form. The national POLST websites (www.polst.org) and the Department of Health websites of each states were used to abstract relevant information for this study.

Result: The majority (98%) of states were actively participating in POLST program. Of 44 POLST forms available to review, 25 POLST forms captured patient's preferences for antibiotic use. Hospital transfer was mentioned on all POLST forms, while IV fluid and antibiotic use were mentioned in 88.6% and 56.8% of times, respectively. There were no significant associations between POLST MATURITY status and the presence of infection-related variables (n=44, X ² =4.2163 P=-.37)^.

Conclusion: Although POLST programs are gaining increased attention as a preferred ACP tool, the usage of the tool in practice to document patient preferences for antibiotic use at EoL varied greatly. Future research is needed to examine regional factors associated with antibiotic use assessment and the actual use of antibiotics at EoL.