Healthcare Professional Education on Portable Orders for Life-Sustaining Treatment (Polst): A Quality Improvement Project

Abstract

Purpose. This quality improvement project aimed to increase healthcare professionals' awareness, knowledge, and confidence in discussing the Portable Orders for Life-Sustaining Treatment form. Additionally, serving to educate providers on best practices and appropriate patient populations when utilizing a Portable Orders for Life-Sustaining Treatment form. Background. It is known that patients in the terminal phases of their diagnosis sometimes struggle to communicate their wishes, an relatives are left to decide for their loved ones unless prior documentation has been performed. Ensuring providers receive proper education on POLST form documentation is essential to ensuring patients make sound decisions concerning end-of-life. Compared to standard orders, POLST forms are five times more likely to align with patient wishes and reflect comfort-focused care. The POLST form is a tool a healthcare provider can use to clearly represent the patient's wishes, specifically as medical orders, including indicating what type of life-sustaining treatment the patient desires. Methods. This quality improvement project utilized the Plan Do Study Act model to address the projects’ aims. A quantitative approach was taken to assess the quality and efficacy of the teaching material through a post-pre survey. Results. Two participants from the Hospitalist group at Evergreen Health Medical Center completed the education intervention and pre-posttest survey. Participants completed six multiple-choice questions to depict the different levels of baseline education on the topic. Participants answered seven Likert-style questions that addressed competence, knowledge, comfort, and familiarity in the POLST form. Of the seven questions, #7 and #12 demonstrated a positive result of a score of “5” on the Likert scale. Common limitations addressed in this project included small sample size in the setting of poor participation related to poor staffing ratio, which, if more appropriate, would lend providers adequate time to participate in continuing education opportunities. Conclusion. Due to poor participation and lack of data, there was insufficient information to infer an appropriate response to this quality improvement project. This data is not representative of the hospitalist population. Although the recruitment group had large internal validity, the lack of respondents led to poor external validity and poor data analysis.