Medical Orders for Life-Sustaining Treatment (MOLST)
Nationally, POLST is a movement to allow Americans better tools in communicating their healthcare wishes. POLST is a portable medical order set used in many states to allow individuals with serious, life-limiting conditions to communicate preferences on resuscitation, intubation, and artificially-administered nutrition and hydration. POLST has different names in different states. In Ohio, we call it Medical Orders for Life-Sustaining Treatment, or MOLST.
Ohio has yet to adopt MOLST as a standard, statewide order set. In the mid-2000s, a group of providers, advocacy groups, consumers, legal experts and other stakeholders came together to advocate for legislation that would implement MOLST statewide. In 2016, SB165 passed the Senate, but failed to gain traction in the House. Since that time, states across the country have begun to discourage codifying POLST, because doing so limits their ability to modify the program as medical practices evolve.
LeadingAge Ohio serves as the convening organization for the Honoring Wishes Task Force, the original coalition of stakeholders that worked to advance MOLST in Ohio. Since 2016, a number of task force members have advanced efforts in their regions to bring attention to advance care planning process generally, and in some cases, employed MOLST as a tool in this process. For example, in southwest Ohio, the Conversations of a Lifetime project advanced the use of MOLST within the Trihealth system and area care partners.
In July 2021, the Honoring Wishes Task Force began meeting monthly to learn from one another and network with professionals and stakeholders across Ohio. To learn more about MOLST and get involved with the Honoring Wishes Task Force, contact Susan Wallace, President/CEO, at firstname.lastname@example.org
Honoring Wishes Task Force Monthly meetings
The Bon Secours Mercy Health team discussed their preperation preparation, launch and progress to implement POLST in partnership with area nursing facilities, and preliminary findings and lessons they experienced along the way.
LeadingAge Ohio’s listened in on a discussion with Dr. Marsha Paul, Medical Director, Hospice of Northwest Ohio, on how Americans arrived at current coding practices and discuss the ethical and legal dilemmas that surround resuscitation and withholding resuscitation. Discussants also considered instances where resuscitation was not a reasonable treatment option and should not have been offered. Lastly, guidelines were provided for having an effective code status discussion with patients and families.
LeadingAge Ohio members were invited to join the monthly Honoring Wishes Networking meeting as Donna Skurzak, MA, CDP describes the cultural insights needed to assist individuals wanting to complete advanced care planning documents. The Honoring Wishes Task Force is a statewide coalition of associations, providers, advocates and other stakeholders working to improve healthcare decision-making and communication in Ohio.
Physician’s Orders for Scope of Treatment (POST): Danielle Funk-Sollenberger, MS (9/28/22)
Danielle Funk-Sollenberger, MS, Manager of the West Virginia Center for End-of-Life Care and WV e-Directive Registry, shared about the Physician’s Orders for Scope of Treatment (POST) use in West Virginia as well as how the state achieved a statewide registry for advance care planning documents, including POST.
Implementing POLST in Health Systems: Dr. Stewart Stein (8/24/22)
Dr. Stewart Stein of Chapters Health System in Temple Terrace, Florida, shared experiences implementing POLST in their health system.
Coalition to Transform Advanced Care: Jennifer Blemur, Esq. (6/29/22)
Jennifer Blemur, Esq. Director of Policy & Advocacy for C-TAC describes the work of C-TAC, as well as the role that state-level advanced illness coalitions can play in improving care in their state. The Honoring Wishes Task Force is Ohio’s coalition of clinicians, health systems, post-acute providers, emergency responders, and other stakeholders focused on improving healthcare decisionmaking and communication.
Goals of care with individuals with cognitive impairment: Leigh Ann Kingsbury (5/25/22)
Leigh Ann Kingsbury of InLeadS Consulting, offered her insights on goals of care conversations with individuals with cognitive impairment. A nationally-recognized expert in person-centered practices and healthcare decisionmaking, Leigh Ann is a frequent presenter and facilitator on advance care planning, advocacy for individuals with disabilities, and legal aspects like guardianship and alternatives to guardianship. Recently she served as facilitator for Ohio’s Alzheimer’s and Related Dementias Task Force convened by the Department of Aging.
The Reports of the Death of ACP are Greatly Overexaggerated: Dr. Susan Hickman, PhD, Indiana University (3/23/2022)
Dr. Susan Hickman of the Indiana University College of Medicine is a nationally-recognized expert on advance care planning research. Dr. Hickman will respond to the recent JAMA article questioning the value of advance care planning.
Implementation of an Evidence-based Structured Advance Care Planning Program for Long-term Care Residents; Alicia Angelo, NP (2/24/2022)
The benefits of advance care planning (ACP) to individuals, their families, and clinicians are well cited in the literature; however, ACP for long-term care residents is frequently insufficient or absent. This presentation will describe a DNP project that uses evidence-based strategies to implement a structured ACP program for long-term care residents.
Innovative Programs for Better End of Life; Barbara Rose, MPH, (12/1/2021)
Barbara Rose provides an overview of the Conversations of a Lifetime Project that was a project that focused on encouraging goals of care discussions in primary care practices across southwest Ohio, coupled with a public awareness campaign encouraging Ohioans of all ages to say the "things you shouldn't wait to say" as an entry point to advance care planning discussions, and to do the things you shouldn't wait to do.
HB7: Update on Ohio's living will law; Michelle Fitzgibbon, (10/27/2021)
Michelle Fitzgibbon represents Lifeline of Ohio, one of Ohio's organ procurement organizations (OPOs), which is charged with coordinating the donation of human organs and tissue for transplantation, helping to save and heal lives in Ohio and beyond. In her role, she was instrumental in the passage of HB7, which made changes to how Ohioans communicate their wishes related to organ donation.
A Higher Register: Elevating advance care planning via document registries; Dr. Zach Rossfeld, MD, MA, FAAP (9/22/2021)
Dr. Rossfeld of Grant Medical Center in Ohio shared his efforts to standardize how his health system records advance directives in Epic, as well as best practices from pioneering states of West Virginia and Oregon, who have led in the creation of single, statewide registries for advance directives and other goals of care documents.
National POLST Update; Judy Black, MD, MHA (9/25/2021)
Dr. Black is Medical Advisor for the Jewish HealthCare Foundation and Past Chair for the POLST (national) Plenary Assembly. Dr. Black considered a founder of the POLST movement and led the adoption of POLST in Pennsylvania. This webinar provided an overview of POLST for newcomers, as well as updates on the latest discussions at the national level, including the adoption of a national form and “best practices” from nearly two decades state-by-state implementation.