Medical Orders for Life-Sustaining Treatment - Professionals
Development of the MOLST Program
The Community-wide End-of-life/Palliative Care Initiative, a Rochester, New York-based initiative aimed at improving end of life care in New York, created the Medical Orders for Life-Sustaining Treatment (MOLST) Program.
Medical Orders for Life-Sustaining Treatment (MOLST) was adapted from an Oregon program called Physician Orders for Life-Sustaining Treatment (POLST). Developed in the early 1990’s, POLST communicates medical orders describing an individual’s preferences for life-sustaining treatments. POLST was designed for use in all care settings including the hospitals, long-term care facilities and the community.
Examples of life-sustaining treatments:
- Cardiopulmonary resuscitation (CPR or “code status”)
- Intubation and mechanical ventilation nutrition and hydration
- Artificial
- Antibiotics
A decade of research in the state of Oregon has proven that the POLST program more accurately conveys end-of-life preferences that are more likely followed by medical professionals. The POLST program has been a key vehicle in Oregon’s successful efforts to increase the effectiveness of advance care planning and decrease unwanted hospitalizations at the end of life. For more information about POLST, please visit www.polst.org
Eager to replicate Oregon’s success, other states are now instituting this model. MOLST is a POLST Paradigm. For more information about the POLST Paradigm, please visit www.polst.org.
Discussions with the New York State Department of Health (NYSDOH) were initiated in March 2004 regarding the MOLST form and program. Collaborative review of the form with NYSDOH resulted in the first revision of the MOLST form in October 2005. The MOLST is consistent with New York State’s laws and regulations NYSDOH has approved this new revised MOLST form for use in health care settings, including hospitals and nursing homes, throughout the state.
Governor Pataki signed the MOLST bill (A.8892, S.5785) establishing a pilot of the MOLST program in Monroe and Onondaga Counties on October 11, 2005. This bill allows for the use of the MOLST form in lieu of the New York State Nonhospital Do Not Resuscitate (DNR) form. The Pilot was officially launched on May 1, 2006.
A Chapter Amendment (A.9479, S.6365), signed by Governor Pataki on July 26, 2006, permits EMS to honor Do Not Intubate (DNI) instructions prior to full cardiopulmonary arrest in Monroe and Onondaga Counties during the MOLST Pilot and provides a carve out for persons with mental retardation and developmental disabilities without capacity.
A Special Thanks...Special thanks to the primary care physicians, emergency room doctors, EMS staff, nurses, pulmonologists, intensivists, palliative care specialists, social workers, lawyers, consumers, long-term care facility staff, hospice workers and home care staff that created MOLST. Click here for a list of members of the MOLST Creation Workgroup. Special thanks to New York State Department of Health (NYSDOH) and the Medical Society of the State of New York (MSSNY) Ethics Committee for their support of the MOLST Pilot legislation and Chapter Amendment, as well as countless community collaborators and professional associations across the state for their support of implementation of the MOLST Program. Special thanks to Excellus BlueCross BlueShield for moving MOLST beyond the Rochester community. |
In This Section
