2011 POLST
Form
Background

Component of POLST Quality
Improvement Process – review
comments/ suggestions every 2 years

POLST Documentation Committee

POLST Task Force

EMSA Commission
California POLST Education Program
© March 2011 Coalition for Compassionate Care of California
Materials made possible by a grant from the California HealthCare Foundation
2
Key Messages

The POLST form is voluntary

Previous POLST forms are still valid

Ensure the Advance Directive and POLST
form are consistent

Emphasize role of the Legally Recognized
Decisionmaker
California POLST Education Program
© March 2011 Coalition for Compassionate Care of California
Materials made possible by a grant from the California HealthCare Foundation
3
Rollout Strategy

Educational Materials:

Summary of the changes with rationale

Minor modifications to POLST curriculum

Newsletter article
Chinese, Spanish, Farsi, Korean,
Russian, Tagalog, Vietnamese

Translations –

Websites

CDPH – AFL and MDS
California POLST Education Program
© March 2011 Coalition for Compassionate Care of California
Materials made possible by a grant from the California HealthCare Foundation
4
Guiding Principle

Changes must provide substantial and
significant improvement or clarification
to the form

In addition:

Maintain one page (two-sided) format

Kept all critical information on front of form
California POLST Education Program
© March 2011 Coalition for Compassionate Care of California
Materials made possible by a grant from the California HealthCare Foundation
5
General Changes


Ultra Pink 65# cardstock

Made by Mohawk

Available at FedEx/Kinko’s
Changed health care ‘professional’ to
health care ‘provider’ – consistent with
language in POLST law
California POLST Education Program
© March 2011 Coalition for Compassionate Care of California
Materials made possible by a grant from the California HealthCare Foundation
6
2011 POLST Form
Original POLST Form
2011 POLST Form
Original POLST Form
2011 POLST Form
Original POLST Form
2011 POLST Form
Original POLST Form
2011 POLST Form
Original POLST Form
Things to Remember

Previous POLST forms remain valid

Best practice – start using new POLST
form after 4/1/11

POLST on any color paper is valid

Copies/faxes are valid
California POLST Education Program
© March 2011 Coalition for Compassionate Care of California
Materials made possible by a grant from the California HealthCare Foundation
17
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