POLST Guidance for Individuals

POLST is a physician order that helps give seriously ill patients more control over their end-of-life care. Produced on distinctive bright green paper and signed by both the clinician and patient, POLST specifies the types of medical treatment that a patient wishes to receive toward the end of life.

Every adult can benefit from having conversations with their health care professionals and trusted people in their life about what they might want for medical care if a sudden emergency, accident, or illness were to happen.

Some Durable Power of Attorney Forms (DPOA - HC) forms allow you to add this information. Or you may want to complete a type of advance directive known as a health care directive which will also ask about your choices for medical care if you are diagnosed with a terminal illness or a condition known as a permanent vegetative state.

You have the power to determine the kind of treatments you want to receive and the kind of treatments you want to avoid.

The decisions documented on the POLST form include whether to attempt CPR, administer antibiotics and IV fluids, use a ventilator to help with breathing, and provide artificial nutrition by tube.

No. Completing a POLST form should always be voluntary.

POLST is designed for seriously ill individuals or those who are in very poor health. Healthy people should have an advance directive.  Later, if the patient became sicker or frailer, they or their power of attorney for healthcare can complete a POLST to turn their treatment wishes into medical orders.

POLST complements an advance directive and is not intended to replace that document. An advance directive is still necessary to appoint a legal health care decision-maker, and is recommended for all adults, regardless of their health status.

A health care professional completes the form after having a conversation with the patient. Once completed, POLST must be signed by both the patient and either their physician (MD/DO), a nurse practitioner (ARNP), or a physician assistant-certified (PA-C).

Yes, you can change your POLST at any time should your preferences for treatment change. It is a good idea to review the decisions on your POLST form when you are transferred between settings, there is a change in your overall health, or your treatment preferences change for any reason.

Without a POLST form, emergency medical personnel, nurses, and physicians would not know your treatment wishes. You will most likely receive all possible treatments, whether you want them or not.

Faxed copies and photocopies are valid. Bright green paper is used to distinguish the form from other forms in the patient’s record; however, the form will be honored on any color paper.

At this time, the Washington state POLST is only available in its standard size—some facilities have on occasion created on their own “pocket” versions of POLST, but these variations of the standard size form are not officially sanctioned by the POLST-sponsoring organizations (the WSMA and the Department of Health).

In Washington state, the Department of Health instructs their paramedics to be guided by the POLST form and only the POLST form. While a “pocket” POLST, or bracelets and necklaces could alert a first responder as to a person’s wishes and may encourage them to find the POLST form, medics in Washington are not allowed to act on directions found on that pocket card or bracelets/necklaces alone.

While some states allow bracelets to serve as instructions to be followed by paramedics in the field, in Washington state, the POLST form is the only set of medical orders approved by the Department of Health that paramedics and emergency medical services teams can follow outside of a medical facility. Bracelets and necklaces could alert a first responder as to a person’s wishes and could certainly encourage them to find the POLST form, but Washington state medics are not allowed to act directions found on bracelets or necklaces alone.

POLST was originally developed in Oregon. There are a number of states that currently have POLST programs in place or that are developing POLST programs. For more information on the national POLST effort, visit it's website. 

If you are traveling to another state, it is a good idea to take both your advance directive and your POLST form with you. Both documents, even if not legally binding, will help physicians and health care professionals know your wishes.

If you are moving, you should bring your POLST with you to your first appointment with your new physician or health care professional to put your wishes on that state’s POLST form (for a list of states with POLST programs, visit the national POLST Program website.  You should also talk to your attorney about updating your advance directive, as some states require you use a specific form in order for your advance directive to be valid.

EMTs in Washington state will do their best to honor other state’s POLST forms as long as the other state form has the basic elements of the Washington form. One significant difference between the Oregon and Washington forms is that a patient signature is required on the Washington state form, but not on the Oregon form. Physicians and patients/surrogates need to be aware that if they choose not to sign an Oregon POLST, it may be harder for EMS or physicians in Washington to honor it.

The Washington POLST will be accepted and honored in Oregon by both EMS and local hospitals.  It’s recommended that a patient fill out a form for the state where they reside.

There is not a state registry in Washington state at this time.