Frequently Asked Questions on the New Jersey POLST Form
You can also download the .pdf version of the POLST FAQ here.
What is a POLST form?
In New Jersey, POLST stands for “Practitioner Orders for Life-Sustaining Treatments.” These are “medical orders” from a physician or advance practice nurse that address patient goals, scope of therapies, artificial nutrition, and resuscitation status.
The form is portable across all health care settings in NJ, from hospital to post-acute levels of care and even in the private home. These orders are actionable and by law must be followed by the medical teams caring for the patient.
How is the POLST form different from an Advance Directive or Living Will?
Both are instructions for health care providers to patients who are unable to speak due to a medical illness such as a stroke or dementia syndrome.
1. Living Will:
In the state of New Jersey, a living will can only be completed by the patient and must be either signed by a lawyer, witnessed by two people, or notarized. This is a document that should be placed on the medical record but is often overlooked or neglected during times of illness. Even when consulted, the living will often contains “legal” language that does not offer clear instruction for the medical staff. Only the patient may complete a living will to address his or her own medical preferences.
2. POLST form:
A POLST form is a medical order sheet that must be followed by the medical team, whether they are emergency first responders in the home, emergency room staff members, or medical teams in a hospital or nursing home. Additionally, the form travels with the patient across these settings as part of the medical record. Ideally, the patient gives consent for the POLST form to be completed by his or her doctor. However, if the patient lacks capacity and cannot make decisions about health care, his or her designated decision maker (Health Care Proxy) may give consent for the POLST form. This is an important distinction from the Living Will, which may only be completed by the patient.
How do I prepare to complete the POLST form with the doctor or nurse practitioner?
Viewing the videos on this website and reviewing the educational materials on the New Jersey Hospital Association website (www.njha.com/polst) will prepare you to complete the POLST form with the help of your doctor or nurse practitioner.
Once you have viewed the videos and reviewed the FAQ on the NJHA website and this website, there should be a discussion between the doctor and the patient (or decision-maker) on the patient’s diagnosis and the prognosis if known.
For whom is the POLST form used and how should it be used in practice?
In the State of New Jersey, the POLST form is recommend for two populations:
1. Those patients entering the final months to final years of life. Because preferences and goals vary among patients, it is critical to document patient preferences on the POLST form.
2. Those patients who may have many years to live but wish to clearly define their preferences of care. This means that any healthy adult may have a POLST form. This is an important distinction that New Jersey makes about using the POLST.
New Jersey Goals of Care is also recommending that the POLST form be completed for all senior adults living in New Jersey and all residents of long-term care facilities. The POLST form is extremely important for that patient who may be facing difficult medical decisions and/or entering the final phases of life. It is a powerful tool for organizing the patient’s medical care around stated goals, which is essential since different patients may have very different goals when faced with a limited amount of time.
What are the “Four Steps” to good medical decision making?
The current model for medical care in New Jersey and most of the United States is a simple two-step model that includes making the diagnosis (step one) and treating the diagnosis (step two). If the diagnosis is high blood pressure, then the treatment is a blood pressure pill. This is often a very appropriate method for the healthier patient with capacity to make decisions. However, for the patient entering a final phase of life with multiple medical problems, such as cancer or dementia, the blood pressure pill may not be the best way to meet the patient’s specific personal goals.
Goals of Care and New Jersey Goals of Care are proposing a Four Step approach for those adults who are very sick or entering into a final phase of life. We are encouraging all doctors, patients, and decision-makers to use this four-step approach:
What is the diagnosis?
What is the prognosis?
What are the patient’s goals of care within the context of this prognosis?
What plan will the medical team develop to achieve the patient’s goals of care?
For seriously ill patients or those entering the final phases of life, we suggest completing the POLST form only after steps one and two have been discussed.
Does the form have to be green in color?
While New Jersey law asks that the original form be green, this is not mandatory. In fact, it is extremely difficult to copy or fax the green POLST form. The law states that xeroxed and faxed copies in black and white are acceptable. The reason many states are choosing to create colored POLST forms is so the first responder can easily locate the form in the household during an emergency. The color of the form need not be an issue if it is kept on the door or presented to the first responder upon entry.
Should I travel with my POLST form?
Yes. The POLST form should go with you if you are traveling to other states. Those states with POLST programs will honor your form should you become sick and are unable to communicate your wishes. Visit www.polst.org to learn which states have POLST programs.
What should I do with the form once it is completed?
Once the doctor or nurse practitioner completes the form, it should be signed by the patient or medical decision-maker. The original copy should remain with the patient, and the doctor should keep a copy in the medical record. We recommend that all specialists involved in the patient’s medical care should also have a copy. A copy can be sent through regular mail or faxed to their offices. Also, it is strongly recommended that a copy be given to the health care proxy, as well as appropriate family members and friends.
Why is the “Do Not Attempt Resuscitation” instruction placed last?
The POLST form corrects a problem commonly encountered in end-of-life decision-making, when the patient’s resuscitation status may unduly influence other decisions about his or her care (e.g, surgery, ICU care, or transfer from a nursing facility back to the hospital).
The NJ POLST form is designed to allow the practitioner first to ask about the patient’s goals, then to make recommendations on the medical care that will best achieve those goals, and finally to make recommendations on resuscitation. It also allows the practitioner to order “Full Therapeutic Efforts” to sustain life, while also allowing a natural death with no resuscitation, if this meets the patient’s goals.
Resuscitation status or “code status” can be a distraction from other questions and should not be overemphasized during end-of-life discussions.
Do all sections of the form need to be completed?
It is not required to complete all of the sections. Any section not completed implies full treatment for that section. Although not encouraged, the form may be used simply to address resuscitation status.
What is the status of POLST in NJ?
The New Jersey POLST bill was signed into law in December of 2011. It was officially released by the Department of Health on February 22, 2013. It is housed in the New Jersey Hospital Association and is available along with educational materials on their website (www.njha.com/polst). Coupled with the POLST bill that was signed into law, the State of New Jersey now requires all licensed physicians and nurse practitioners to complete at least two hours of Continuing Medical Education (CME) on this topic.
How is the NJ POLST form different from other POLST forms across the country?
The primary distinction is the way in which items are arranged on the form. The NJ POLST starts with the patient’s Goals of Care and ends with Resuscitation Status. The form provides a very natural order for the discussion of life sustaining treatments. Starting with the question, What are your hopes for the future?, provides the context in which to discuss appropriate medical treatments, including resuscitation. Because of its structure, the NJ POLST form may be used as a template or script for framing bedside discussions of end-of-life care. You may view POLST forms from other states at www.polst.org.
How will the POLST form impact care in New Jersey?
New Jersey Goals of Care is making a statewide effort to assist all hospitals and skilled nursing facilities to adopt the NJ POLST form as their advance care planning worksheet. This eliminates extra work for the medical teams and should streamline care for the patient. This also ensures that health care decisions will be honored across settings. New Jersey Goals of Care has also created a POLST-compatible worksheet designed to help the patient or decision-maker outline the patient’s goals prior to meeting with the doctor or nurse practitioner to complete the POLST form.
For more information on POLST in New Jersey, you may consult the New Jersey Hospital Association at www.njha.com or contact NJGOC at firstname.lastname@example.org. For more information on POLST nationwide, you may visit www.polst.org.