Transcript Having the POST Conversation

Kathy Sample BS, LSW
Grace Healthcare
Pat Bader FNP-BC ANP
Primary Care Specialists
With Whom?
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Spouse
Children
Siblings
Friend
Partner
Niece/ Nephew/ Aunt Uncle/Cousin
Guardian
Appointed HCA
When?
• On admission to hospital?
• On admission to the Nursing Home?
• In the Assisted Living Community?
• In the Office?
• At Home?
• When there is a change in condition?
By Whom?
• Physician?
• Nurse Practitioner?
• Social Worker?
• Case Manager?
• Admission Director in Nursing Home?
• Administrator in Assisted Living?
• Chaplain?
• Hospice?
Scripting
General Recommendations
• Acknowledge importance of the decisions
• Discuss issues with the chosen surrogate
or loved one
• Avoid communicating personal values and
preferences
• First: Explore the understanding
• Then: Provide the information
Scripting
CPR/ no CPR
• We need to discuss whether or not you
would want attempts to re-start your
heart or breathing if your heart or
breathing suddenly stopped
• What is your understanding of CPR?
• Do you fears or concerns about making
this decision?
Scripting
Medical Interventions
• You have chosen (CPR or no CPR)…..
• There are 3 categories of choices to discuss:
• Comfort Care includes measures to control symptoms
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you may experience
Limited Interventions include IV medications, no
breathing machine or intubation but usually means going
to the hospital
Full Treatment requires going to the hospital and
involves ICU, intubation and a respirator to help
breathing
Scripting
Antibiotics
• What do you understand about antibiotic
usage?
• Antibiotics may be used for a new
condition
• Antibiotics may be given by mouth or in a
shot or IV
Scripting
Medically Administered Fluids & Nutrition
• What is your understanding of medically
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administered nutrition and hydration?
Oral foods and fluids are offered if medically
feasible
Would a feeding tube be acceptable?
Would IV fluids be acceptable?
Do you have fears or concerns about making
this decision?
Information Transition
• POST should follow
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the patient from one
point of care to
another
Corporate regulations
for POST forms
should be in line with
the intent of the form
• Education is critical to
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appropriate use of the
POST
POST status needs to
be part of the report
from one facility to
another
DNR does not mean
Do Not Treat
References/ Resources
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• WEBSITES
Center to Advance Palliative Care www.capc.org
End of Life Physician Education Research Project www.eperc.mcw.edu
Growth House www.growthhouse.org
MOLST resources www.compassionandsupport.org
National Hospice and Palliative Care Organization www.nhpco.org
POLST resources www.polst.org
• BOOKS
Dunn, Hank, Hard Choices for Loving People (www.hardchoices.com)
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• Lynn, J., Harold, J., Handbook for Mortals (www.amazon.com)
Questions?