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Health Advisory: COVID-19 Updates for Providers (Apr. 17, 2020)

Published April 17, 2020.

Requested actions

  • Be aware DOH and Washington State Medical Association have implemented Physician Orders for Life-Sustaining Treatment (POLST) and a COVID-19 POLST statement, helping patients summarize their wishes for end-of-life treatment.
  • Consider speaking with your high-risk patients about life-sustaining treatment and POLST during the COVID-19 pandemic.

Background

What is a POLST?

  • Physician Orders for Life-Sustaining Treatment (POLST) represents a patient’s wishes as clear, specific medical orders.
  • POLST overcomes the limitations of traditional advance directives, indicating which types of life-sustaining treatment patients want (or do not want) at the end of life, including:
    • Resuscitation.
    • Medical interventions.
    • Antibiotics.
    • Artificial nutrition.
  • The completed POLST is a physician order form that remains with the patient.
    • The POLST goes with the patient from one healthcare setting to another, whether they are at a hospital, home or long-term care facility.
    • Healthcare facilities may wish to keep a duplicate copy in the patient’s medical record upon discharge.

POLST “dos and don’ts”

  • Do remember to sign and date the form. Both clinician and patient (or surrogate) signatures are required. A process may need to be developed for telemedicine visits.
  • Don’t pre-sign forms.
  • Do be aware that, while POLST can be signed by a surrogate, it is best if it is signed by the patient and agrees with the patient’s prior directives.
  • Don’t send the form home with a patient to fill out on their own. If a patient wants to show the form to their family or surrogate decision-maker, do make an appointment to have them review it with you for final decisions and signatures.
  • Do make sure the patient understands the treatment options at each level of care.
  • Do discuss non-emergency medical treatment preferences (section D) and indicate if the patient’s preferences limit the use of antibiotics or artificial nutrition.
  • Do recognize that a patient wishing DNR for cardiopulmonary arrest might still want full treatment. This can be indicated by checking DNAR in section A and Full Treatment in section B. In general, CPR in Section A should always link with Full Treatment in section B since CPR frequently includes intubation and ICU care.
  • Do consider introducing POLST to Alzheimer’s patients while they can consider and sign the documents themselves. Discuss “down the road” scenarios thoroughly, so patients can amend prior documents to properly instruct their families about future choices.
  • Do work with administrators where you are attending or medical director to ensure a timely process for discussing and completing POLST.
  • Do be aware that, while Medicare requires healthcare facilities to ask about advance care planning documents, it prohibits them from compelling or requiring patients to have them.

More information

Situation update

As of April 17, Pierce County has 1,086 COVID-19 cases and 28 deaths.

Graph of Pierce County COVID-19 cases. For more information, call (253) 798-6410. 

Reporting

Healthcare providers should call (253) 798-6410 to report COVID-19 cases in the following people.

  • Healthcare workers (e.g., EMS, medical, nursing, any healthcare facility employee).
  • Public safety workers (e.g., law enforcement, firefighter).
  • People who live or work in a long-term care facility, senior living center, permanent supportive housing or similar congregate setting (e.g., shelter, correctional facility) housing people at high risk for severe outcomes.
  • Any person who dies with COVID-19.

Patient communication

Share these materials with patients.

Contacting the Health Department

  • Urgent issues—Call (253) 798-6410 and press 0.
  • Non-urgent issues—Call (253) 798-6534 and leave a message. Includes reporting notifiable conditions 24 hours a day, 7 days a week. Leave the patient’s name, date of birth and disease.

Additional resources

 

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