Making End-of-Life Wishes More Available to Caregivers Video

Wanda Puckett was 85 when she arrived at a hospital from her Eastern Oregon home for what she thought was a gallbladder attack. It turned out that she had a leaky artery. When her condition worsened, she was airlifted to a bigger hospital in the s...
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Andrew Holtz: Wanda Puckett was 85 when she went into a hospital from her eastern Oregon home with what she thought was a gallbladder attack. It turned out, she had a leaky artery. Her condition worsened. She was airlifted hundreds of miles to a large hospital in Portland, but things did not go well. Puckett spent several days on life support until her family decided to remove the tubes and machines. Puckett never intended to die this way. Tucked away in a file cabinet in her home was a POLST form. POLST stands for Physician Orders for Life Sustaining Treatment. Puckett had filled out the form with her doctor and documented that she did not want to be placed on a breathing machine if she couldn’t communicate and only wanted easy things fixed. But when her final health crisis hit, health care workers didn’t have POLST form, and so her end of life instructions weren’t followed. Oregon and a handful of other states are looking to change that outcome. Oregon is the first state to create a registry intended to make sure people’s wishes are known when they can’t speak for themselves. If emergency medical professionals don’t have access to clear medical orders, they’re generally obliged to attempt for resuscitation regardless of what the patient really wanted. The new registry is available to emergency responders and other health care providers by telephone 24 hours a day, 365 days a year. So far, roughly 4,000 POLST forms have been submitted to the computerized registry. It went live in Oregon in early December. In the first couple of weeks, there were half a dozen urgent request for instructions. One of those matched a patient whose POLST form was available in the new system. The director of the project says the biggest hurdles have been getting the word out to patients and medical providers. So they’ll submit POLST forms and they’re getting emergency cruise to call when they don’t know what a patient wants. Female: Right now, we’ve been getting them at a rate of about 100 a day. So at that rate, it will take a number of months. Our actual goal is not a number, but to really pretty much have them all there, so that when the MS calls and looks for it, we actually have it. Andrew Holtz: Here’s how the POLST database in Oregon works. Patients fill out a bright pink form with their medical provider, checking off if they want CPR or medical interventions like airway treatments or feeding tubes. Then the form is sent to Oregon Health and Science Universities Emergency Communication Center in Portland where the registry is housed. If an ambulance is called to the home of the patient, the crew can call a telephone number and a live person, not a recording, will relay the patient’s medical orders in real time. The budget for the Oregon project, which includes operating and education costs is estimated at $1.7 million over two years. The dollars needed to run the registry will come from the State’s general fund in matching federal dollars, while the funding to educate health care professional statewide will be raised privately. Other states are placed to follow Oregon’s lead. Bud Hammes, a medical ethicist at Gunderson Lutheran Hospital in all across Wisconsin, said he’s watching closely. Bud Hammes: Oregon is taking, I think, an important step in looking towards the future of how medical information is going to be stored and retrieved and if you’re not awake to do that, that’s faith and reliable. Andrew Holtz: Hammes is quick to point out that its purpose is to help make sure health care providers follow a patient’s wishes whether it’s to be allowed to slip away at the end of life or to urge emergency cruise to every treatment at their disposal.

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