Having the POST Conversation Kathy Sample BS, LSW Grace Healthcare Pat Bader FNP-BC ANP Primary Care Specialists
With Whom? • 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 • • 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 • • 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 • 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 • • appropriate use of the POST status needs to be part of the report from one facility to another DNR does not mean Do Not Treat
References/ Resources • • 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) • • Lynn, J. , Harold, J. , Handbook for Mortals (www. amazon. com)
Questions?
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