Oregon POLST Webinar with Drs. Susan Tolle & Abby Dotson - Jan 14, 2020

This video is of the “POLST: What’s New In Oregon?” Webinar from January 14, 2020 with Susan Tolle, MD, Chair, Oregon POLST Coalition and Abby Dotson, PhD, Director, Oregon POLST Registry (OPR). It highlights the recent innovative advances made and challenges experienced by the Oregon POLST Program, Oregon POLST Coalition and the Oregon POLST Registry. The highlights include: New Developments with the Oregon POLST Registry, Major Changes in the Oregon POLST Form, Comments by Primary Care, 2019 Educational Innovations, New Policy and Statutory Changes, Areas of Further Work Planned in 2020, How to do a better job of checking for POLST forms in the ED,
The Oregon POLST Registry: Is a secure electronic record of POLST orders. Allows emergency medical professionals access to POLST orders if the original POLST orders cannot be found. Is a back-up system and does not replace original POLST forms.
Planned Upgrades to OPR’s Technology with Complete platform rebuild and Reduction of POLST form entry time into the Registry database with better accuracy and Optical character recognition built-in and Fast toggle among acceptable form-year designs and Flexible architecture to stay compliant with future updates.
OPR Interoperability Features with Direct POLST form creation and submission to the Registry for healthcare providers and Automated quality reporting available with integrated analytics and permissions, including: Number of submissions, Section A metrics (% CPR vs % DNR), Gender and average registrant age, and Time from form completion to OPR receipt. Plus, Electronic POLST availability to EMS agencies with Drop-in snippet of code will allow ePCRs to securely search the POLST database and Emergency hotline access to forms will still be available.
GAO Showcases Oregon POLST Program and Registry - The February 2019 GAO (United States Government Accountability Office) report featured Oregon, California, West Virginia and Idaho for their innovations in advance care planning.
Major Changes in the POLST Form with: ‘Physician’ changed to ‘Portable’ to be more inclusive, Pink border rather than solid pink form, and Removal of the feeding tube section.
Response to Removal of the Section on Artificially Administered Nutrition
Calls to Emergency Communications Center (ECC): 500,000 POLST forms submitted, 13,000 calls to ECC, and The ECC has never provided information about feeding tubes.
Oregon Chapter of the American College of Emergency Physicians Endorsed Removal of Tube Feeding Section: Approved by the Board of Directors of the Oregon Chapter of the American College of Emergency Physicians: September 26, 2019.
Oregon Geriatrics Society Endorsed Removal of Tube Feeding Section: Approved by the Oregon Geriatrics Society Board of Directors: November 18, 2019.
Oregon POLST Coalition Reaffirmed Physician Assistants’ Ability to Sign POLST Forms Without the Counter Signature of their Supervising Physician: Approved by the Oregon POLST Coalition: October 17, 2019.
Physician Assistants’ Scope of Practice: Oregon has authorized PA signers of POLST forms since 2007 and CMS approved Physician Assistants to serve as the hospice attending in 2019.
Statewide Conversion to the 2019 Form was Rapid with Vynca ePOLST live on January 2, 2019, Majority of forms to OPR were the 2019 version by July, and In November, 82% were 2019 version.
The Oregon POLST Program distributed 153,000 POLST forms in 2019.
2019 Educational Innovations, including: ‘Understanding POLST’ video, POLST Guidebook, Expanded Portfolio of Patient Stories, and the Major Push to Improve Communication Skills Training at OHSU with Medical Student Testing, Vital Talk Initiative, and New Endowed Chair: Doris & Mark Storms Chair in Compassionate Communication.
New Policy and Statutory Changes Effective Jan 1, 2020, including SB 178 that Broadens who can sign to enroll patients in hospice as a surrogate and SB 1039 that Requires a Health Care Advocate to provide information about a patient’s wishes, values, and what provides comfort to the health care team making decisions about life-sustaining treatment.
Areas of Further Work Planned in 2020 to address: Use information from Registry to improve quality and reduce the over use of POLST in those who are “too healthy” with Rising rates of CPR/full treatment orders submitted to Registry.
We need to do a better job of checking for POLST forms in the ED with the OHSU Trauma Protocol and Oregon ACEP Recommends Protocol to Check POLST: "The Oregon Chapter of the American College of Emergency Physicians (Oregon ACEP) recommends that Emergency Departments implement a protocol to routinely check for Portable Orders for Life-Sustaining Treatment (POLST) forms for anyone 85 or older, and anyone coming to the ED from a residential care facility." Approved by the Board of Directors of the Oregon Chapter of the American College of Emergency Physicians: September 26, 2019