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Guide to Writing Hawaii Polst

Completing the Hawaii Provider Orders for Life-Sustaining Treatment (POLST) form is an important process for ensuring that an individual's health care preferences are understood and respected. The form is designed to communicate these preferences clearly to health care professionals, particularly in situations where the patient is unable to communicate for themselves. It's essential to follow each step carefully to ensure the form reflects the patient's wishes accurately.

1. Start with Section A - Cardiopulmonary Resuscitation (CPR): Decide if CPR should be attempted if the person has no pulse and is not breathing. Mark the appropriate box for "Attempt Resuscitation/CPR" or "Do Not Attempt Resuscitation/DNAR (Allow Natural Death)."
2. Proceed to Section B - Medical Interventions: Choose the level of medical interventions desired by checking one of the options: "Comfort Measures Only," "Limited Additional Interventions," or "Full Treatment." Each choice provides a different level of care, so it's crucial to select the one that aligns with the patient's wishes.
3. Fill in Section C - Artificially Administered Nutrition: Indicate whether the person wants to receive artificial nutrition by tube and, if so, whether for a defined trial period or long-term.
4. Review Additional Orders: If there are any specific orders not covered in the sections above, include them in the "Additional Orders" space provided.
5. Complete Section D - Signatures and Summary of Medical Condition: This section must be completed by the patient or their legally authorized representative (LAR) and the health care provider (Physician/APRN licensed in the state of Hawai‘i). Ensure the provider includes their signature, printed name, phone number, date, and provider license number. The patient or LAR should also sign and print their name and indicate their relationship to the patient.
6. For the Patient’s Preferred Emergency Contact or Legally Authorized Representative Information: Fill in the name, address, and phone number of the patient’s emergency contact or LAR.
7. If applicable, fill in Section E - Surrogate Selected by Consensus of Interested Persons: Complete this section if a surrogate has been selected through consensus. This includes a signature, printed name, and relationship to the patient.
8. Review and Send Form: Once completed, review the form to ensure all information is accurate and reflects the patient's wishes. This form should accompany the patient whenever they are transferred or discharged. A copy should be kept with the patient’s health records.

Remember, the POLst form is a critical document that ensures a person's healthcare preferences are honored. It's a good practice to review and update the form regularly, especially when the individual's health condition or preferences change.

1. What is a POLST form and who should have one?

   A POLST form, which stands for Provider Orders for Life-Sustaining Treatment, is a medical order form that outlines a patient's wishes regarding treatments at the end of life. It is intended for individuals with serious health conditions or who are at the end of their life. This form ensures that the patient’s treatment preferences are known and followed by healthcare professionals, particularly in emergency situations where the patient may not be able to communicate their wishes.

2. How does the Hawaii POLST form respect a patient's wishes?

   The Hawaii POLST form is designed based on the patient’s current medical condition and their personal wishes regarding life-sustaining treatment. For each section not completed, it is assumed that the patient opts for full treatment. This form allows the patient to make informed decisions about CPR, medical interventions, and artificially administered nutrition, and ensures that these decisions are respected and adhered to by healthcare professionals.

3. Who can fill out and sign the Hawaii POLST form?

   The POLST form must be completed by a health care professional, based on the patient's preferences and medical indications. It is valid only if signed by a physician or Advanced Practice Registered Nurse (APRN) licensed in the state of Hawaii and the patient or the patient’s legally authorized representative (LAR). Verbal orders are not acceptable, emphasizing the necessity for written consent to ensure the patient's wishes are clearly documented and legally recognized.

4. Can a POLST form be changed once it is completed?

   Yes, a POLST form can be modified or voided if a patient’s treatment preferences change. To do so, the patient, or their legally authorized representative if the patient lacks capacity, should draw a line through sections A through E, write "VOID" in large letters on the original form and all copies, and then sign and date it. A new POLST form should be completed to reflect any modifications in the treatment plan. This flexibility allows for the patient's current wishes to be respected should their condition or preferences change over time.

5. Is a photocopy of the Hawaii POLST form valid?

   Yes, the use of the original form is strongly encouraged to avoid any confusion or misdistribution. However, photocopies and faxed copies of a signed POLST form are legal and valid. This ensures that a patient's treatment preferences are honored, even if the original document is not physically present, by allowing healthcare professionals access to a copy that is just as legitimate as the original.

6. How often should a Hawaii POLST form be reviewed?

   It is recommended that the POLST form be reviewed periodically. Such reviews are particularly important when the patient is transferred from one care setting to another, undergoes a substantial change in health status, or changes their treatment preferences. Regular reviews ensure the form accurately reflects the patient’s current wishes and medical condition.

7. Who can act as a legally authorized representative (LAR) when completing the POLST form?

   A legally authorized representative can be a guardian, an agent designated in a Power of Attorney for Healthcare, a patient-designated surrogate, or a surrogate selected by consensus of interested persons in the absence of a pre-appointed agent or guardian. The LAR acts on behalf of the patient to ensure the patient's healthcare preferences are respected, especially in cases where the patient lacks the capacity to make decisions themselves.

When filling out the Hawaii Provider Orders for Life-Sustaining Treatment (POLST) form, it's important to approach the task with attention to detail to ensure that the document accurately reflects the intended medical care preferences. Avoiding common mistakes can make a significant difference in the quality of care and can alleviate potential stress for both patients and their families. Here are ten typical mistakes to avoid:

1. Not discussing the form with the patient or their legally authorized representative (LAR) before completion, leading to orders that may not truly reflect the patient's or LAR's wishes.

2. Failing to fill out every section, which could result in the assumption of full treatment in areas not covered, potentially against the patient's wishes.

3. Misinterpretation of the sections, such as the differences between 'Comfort Measures Only,' 'Limited Additional Interventions,' and 'Full Treatment,' which can significantly impact the patient's quality of life and end-of-life care.

4. Overlooking the directions for artificially administered nutrition, thereby not accurately recording the patient's preferences for nutrition by tube, which could lead to unwanted procedures or interventions.

5. Not clearly specifying the choice of 'Do Not Attempt Resuscitation/DNAR' or 'Attempt Resuscitation/CPR,' creating confusion in emergency situations where time is critical.

6. Omitting contact information for the patient’s preferred emergency contact or legally authorized representative, complicating communication in critical moments.

7. Incorrect or missing signatures, including those of the patient or their legally authorized representative and the healthcare provider, which are essential for the form's validity.

8. Not reviewing and updating the POLST form when the patient's medical condition or preferences change, resulting in orders that no longer align with the patient’s current wishes or condition.

9. Using a photocopy of an old form instead of starting a fresh document for updates, which can lead to confusion or mix-ups with outdated orders.

10. Not sending the completed POLST form with the patient when they are transferred or discharged, resulting in a lack of continuity in care across different healthcare settings.

Avoiding these mistakes requires careful review, thoughtful discussion with all stakeholders, and diligent adherence to the guidelines provided in the POLST documentation. Ensuring that these steps are meticulously followed can help respect the patient's healthcare wishes and provide them with the quality of care they desire and deserve.

When planning for health care decisions in Hawaii, especially near the end of life or during critical health situations, the Hawaii Physician Orders for Life-Sustaining Treatment (POLST) form is an essential document. It helps ensure that a person’s wishes regarding medical treatment are followed. To complement and provide a broader context to a patient's wishes beyond what is covered in a POLST, several other forms and documents are commonly used alongside it. Each serves a specific purpose in the landscape of advance care planning and medical decision-making. Let’s explore some of these important documents.

• Advance Health Care Directive: This legal document allows a person to outline their health care preferences in detail, including end-of-life care, and appoint a health care power of attorney to make decisions on their behalf if they are unable to do so.
• Durable Power of Attorney for Health Care: This specifies the individual (agent) appointed to make health care decisions for someone if they become incapacitated and cannot make decisions themselves. It can be part of the Advance Health Care Directive.
• Living Will: A Living Will is a written, legal document that spells out the types of medical treatments and life-sustaining measures an individual wants or doesn't want, such as mechanical breathing, tube feeding, or resuscitation.
• Do Not Resuscitate (DNR) Order: Separate from a POLST, a DNR order is a request not to have CPR if a person’s heart stops or if they stop breathing. It is a doctor's order that is entered into the medical record.
• Medical Power of Attorney (POA): This document assigns an agent the authority to make all types of health care decisions, not limited to end-of-life ones, in the event the person is unable to express their wishes.
• HIPAA Authorization Form: This form permits health care providers to disclose health information to the people the patient specifies, helping ensure that loved ones and decision-makers have the information they need to make informed decisions.
• Five Wishes Document: An alternative to the traditional advance directive, this document goes beyond medical issues to address personal, emotional, and spiritual needs as well. It helps guide families and healthcare providers in understanding the patient’s wishes in a broad and comprehensive manner.

Utilizing these documents in conjunction with the Hawaii POLST form can provide a comprehensive and clear directive concerning medical treatment preferences. They ensure that an individual’s health care choices are respected and followed, particularly during critical moments when the person might not be able to express their decisions. Thoughtful completion and regular updating of these documents are key steps in effective health care planning, providing peace of mind for individuals and their families.

The Hawaii POLST form is similar to a Living Will and a Durable Power of Attorney for Health Care (DPAHC), but with notable differences in focus and application. A Living Will typically documents a person's preferences for end-of-life care, especially concerning life-sustaining treatments. It is activated when the individual is incapacitated and unable to communicate their health care decisions. The Hawaii POLST form, while also focusing on end-of-life care preferences, translates these wishes into medical orders that are effective immediately upon signing. This means that health care providers can follow the POLST orders without needing to interpret or infer the patient’s wishes from a more general document.

Similarly, the Durable Power of Attorney for Health Care allows an individual to appoint someone else to make health care decisions on their behalf if they are unable to do so. This document covers a broader range of health decisions, not just those at the end of life. While the DPAHC appoints a health care agent, the POLST form directly records specific medical orders regarding treatments such as CPR, ventilation, and artificial nutrition. Both are important in ensuring that a patient's health care wishes are respected, but the POLST form serves as a complementary document that provides clear, immediate guidance for emergency medical personnel and other health care providers. It is particularly useful in situations where quick decisions are necessary and the appointed health care agent may not be available to consult.

When completing the Hawaii POLST (Provider Orders for Life-Sustaining Treatment) form, it's important to make informed choices that align with the individual's health care preferences and legal requirements. Here's a list of dos and don'ts to help guide you through the process:

• Do have a detailed conversation with the patient or their legally authorized representative (LAR) about their medical condition, values, and what they want and don't want in terms of life-sustaining treatment.
• Do ensure that the form is completed by a licensed Hawaii Physician or Advanced Practice Registered Nurse (APRN), as verbal orders are not acceptable and the form must be signed to be valid.
• Do use the original POLST form if possible, although photocopies and faxes of signed forms are legal and valid.
• Do not leave any sections of the POLST form blank, as any incomplete section implies full treatment for that section.
• Do not use a defibrillator (including automated external defibrillators) on a person who has chosen “Do Not Attempt Resuscitation/DNAR (Allow Natural Death)” under Section A of the form.
• Do review the POLST form periodically, especially when the person is transferred from one care setting to another, there is a substantial change in the person's health status, or the person's treatment preferences change.

It's also crucial to respect the decisions made by the patient or their legally authorized representative, making sure these choices are clearly documented on the form. These steps ensure that the POLST form accurately reflects the patient's end-of-life care preferences and complies with Hawaii's legal requirements.

When it comes to the Hawaii Provider Orders for Life-Sustaining Treatment (POLST) form, various misunderstandings can lead to confusion for patients, their families, and healthcare professionals. Below are seven common misconceptions about the Hawaii POLST form and clarifications to help dispel these misunderstandings.

• Only for the elderly: A common misconception is that the POLST form is intended only for elderly individuals. In reality, it's designed for anyone with a serious illness or frailty, regardless of their age. It helps ensure that their wishes regarding life-sustaining treatments are understood and respected.
• It's the same as a will: Some people think the POLST form is similar to a will. However, it's quite different. While a will deals with the management of an estate after someone's death, a POLST form provides specific instructions for medical treatment based on the person's current health condition.
• Legally binding across all states: Although POLST forms are recognized in many states, the specifics and the form itself can vary from state to state. A Hawaii POLST may not be automatically valid in other states, so it's important to understand the differences and preparedness required when traveling or moving.
• Cannot be changed: A significant misunderstanding is that once completed, the POLST form cannot be revised. Patients or their legally authorized representatives can update the form as their medical conditions or treatment preferences change.
• Replaces other medical directives: Some individuals believe that if they have completed a POLST form, they no longer need other forms of advance directives, such as a living will or healthcare power of attorney. However, these documents serve different purposes and can complement each other in ensuring a person's healthcare wishes are fully outlined and honored.
• Automatically opts out of emergency care: There's a misconception that by selecting "Do Not Attempt Resuscitation," the individual is refusing all types of emergency care. This is not accurate. The POLST form allows for nuanced decisions, such as accepting certain treatments while declining others (e.g., choosing comfort measures but declining CPR).
• Only a doctor can complete it: While a physician or Advanced Practice Registered Nurse (APRN) licensed in Hawaii must sign the POLST for it to be valid, the form's content should reflect a thorough discussion between the healthcare provider, the patient, and, when appropriate, the patient's family or legally authorized representative. This collaborative approach ensures the form accurately represents the patient's wishes regarding life-sustaining treatments.

Understanding these facets of the Hawaii POLST form can help patients and their loved ones make informed decisions about their healthcare, ensuring their values and preferences are respected during critical moments.

Filling out and using the Hawaii POLST (Provider Orders for Life-Sustaining Treatment) form requires careful consideration and discussion between a patient and their healthcare provider. Here are five key takeaways to understand before completing the form:

• It's vital to ensure the form reflects the person's current medical condition and wishes. Incomplete sections are interpreted as a preference for full treatment in that area.
• Choices regarding CPR (Cardiopulmonary Resuscitation), medical interventions, and artificially administered nutrition have distinct implications. For instance, selecting "Do Not Attempt Resuscitation" means no efforts will be made to revive the person if their heart stops or if they stop breathing.
• The form allows for detailed preferences regarding the extent of medical intervention desired, from comfort measures only to full treatment, including intensive care. This enables individuals to have control over how they are treated in various medical scenarios.
• A legal or designated representative can sign the POLST on behalf of the patient if the patient is unable to do so. This ensures that the patient's wishes are respected, even if they're not in a position to communicate.
• The POLST form should accompany the patient whenever they are transferred between care settings or discharged, guaranteeing that their treatment preferences are known and respected across different healthcare environments.

Remember, the POLST form is a legally binding document once it is completed and signed by both the healthcare provider and the patient or their legally authorized representative. It can be modified or voided by the patient at any time to reflect changes in their health status or treatment preferences. Review and updating of the POLST are recommended whenever the patient's health status changes significantly, or there is a change in care setting or treatment preferences.