Honoring Patient Wishes: Implementing Physician Orders for Life Sustaining Treatment
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Authors
Megan Jackson
Issue Date
2025
Type
Thesis
Language
Keywords
Nursing
Alternative Title
Abstract
Purpose Rising healthcare costs are a growing concern for the nation. There are several factors affecting the increased cost of health care. Two major factors are emergency room visits and hospital admissions. Between 20-40% of these patients will have a preventable admission (Browne et al., 2024). Hospital admission rates and the number of emergency room visits are two factors that are important for long-term care facilities. These elements correlate with quality measures through the Center of Medicare and Medicaid. A long-term care facility in Alaska has noticed an increasing number of hospital admissions and emergency room visits in their population over the last two years. This year hospital admission rates for 2024 were 0.49 hospital admissions per resident day which is up from 0.29 in 2023. Emergency room visits are also on the rise. In 2023 there were 0.73 emergency room visits per resident day, by the end of the fourth quarter in 2024 this was elevated to 1.30. The use of physician orders for life sustaining treatment (POLST) forms have shown to benefit long-term care facilities. Jennings (2022) showed those facilities who used POLST forms had higher star ratings by the Centers for Medicaid and Medicare Services, indicating higher quality. Two quality indicators included in this star rating system are hospital admission rates and emergency room usage. POLST forms will help the long-term care population by preventing unnecessary emergency room visits and hospital admissions. Tark (2021) showed that states with fully developed POLST programs had a 12% increase in those who did not return to the hospital or have emergency room visits at the end-of-life. Demonstrating that POLST form completion decreases unwanted and unnecessary emergency room visits and hospital admissions at end-of-life. The gap in literature is identifying what psychosocial factors can help decrease hospital admissions and emergency room visits. In residents in a long-term care facility how does implementing Physician Orders for Life Sustaining Treatment (POLST) forms compared to prior practice impact the rate of hospital admissions and emergency visits in eight weeks? Implementation Plan Implementation took place over an eight-week period. During the first week of implementation staff were educated on the purpose and use of the POLST form using standardized education material through AK POLST. During weeks one through eight the provider met with residents and families to complete POLST forms. During weeks two through eight the provider met with staff once a week to discuss obstacles, questions, and current use of the POLST forms. There was also a provider on call to address any issues regarding POLST forms. Data Collection Data was collected by the quality improvement team using facility software and is available for review. Data was analyzed using paired T-test collecting before and after POLST implementation data for hospital admissions and emergency room visits using simple descriptive statistics.