DNR/DNI stands for “Do Not Resuscitate – Do Not Intubate”. POLST stands for “Provider Orders for Life Sustaining Treatment”.
Both forms address whether or not cardio-pulmonary resuscitation (CPR) is to be administered, but the POLST form also addresses other life-sustaining interventions.
CPR involves treatments to try to restart a person’s heart after it has stopped beating.
When the heart stops beating, the person becomes unconscious within seconds due to the lack of blood going to the person’s brain. Permanent brain damage is likely if blood flow to the brain is disrupted for more than a few minutes. Thus, denial of CPR may be preferable in situations when it is uncertain how long the blood flow has been interrupted or when the person is old and frail with an incurable illness.
CPR may trigger broken ribs and bruised or punctured lungs from the downward pressure on the chest.
Without acceptable direction to the contrary, medical professionals act to keep the patient alive. For example, when paramedics in many jurisdictions in Minnesota respond to an emergency call, they are required to attempt resuscitation unless a DNR/DNI order is produced at the scene.
A DNR/DNI order is most likely to be available if the dying person is already hospitalized or living in a nursing home. When the patient is already residing in those places, the DNR/DNI order may be placed by the attending physician on the patient’s medical chart.
In cases where the person is not in a hospital or nursing home, the Minnesota Medical Association recommends usage of the DNR/DNI form.
As noted, the POLST is broader than the DNR/DNI order in that the POLST also addresses life-sustaining interventions beyond CPR. A POLST may indicate whether to provide limited treatment of new or reversible illness, or to only provide comfort care. Other options are whether to offer antibiotics, and whether to offer tube feeding if food and liquids can no longer be taken via mouth.
In Minnesota, the POLST may be signed by medical professionals other than the patient’s physician. For example, it may be signed by an advance practice registered nurse, a doctor of osteopathy or a physician assistant. It is preferred that the patient or health care agent of the patient also sign the document to indicate consent to the directives given in the POLST.
The POLST form, which is not specifically authorized under Minnesota’s statutes, relies on Minnesota law generally, which allows advance health directives. It qualifies as a physician’s order under paramedic regulations.
The POLST order can be changed or revoked.
The POLST form at https://www.mnmed.org/portals/mma/pdfs/POLSTform.pdf is provided by the Minnesota Medical Association.
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