Over the summer, a friend’s elderly father underwent resuscitation and intubation because his nursing facility could not locate his Do Not Resuscitate Order (DNRO) or Advanced Directive (AD). These aggressive interventions caused significant distress and confusion for his family, who had expected his care wishes to be honored. If he had lived in a state such as Oregon with a Physician Orders for Life-Sustaining Treatment (POLST) document and the accompanying electronic registry, his wishes would have been easily accessible, interpretable, and respected. How can the healthcare profession prevent this from happening in our state? New legislation is being filed for a Patient-Directed Medical Order (PDMO) document designed to address the shortcomings of the ADs and DNRO forms—currently the primary tools for addressing end-of-life care preferences in Florida.
The PDMO form originates from the POLST paradigm, which has been adopted by most states since its inception in Oregon in the early 1990s (National POLST, 2022). Healthcare professionals recognized that many individuals were not receiving the end-of-life care outlined in their ADs and DNROs due to accessibility, clarity, and practicality (National POLST, 2022). These forms often got lost in file cabinets, were overlooked during emergencies, or rendered ineffective because they were outdated or unclear, particularly during care transitions (Spillers & Lamb, 2011).
While ADs and DNROs are valuable tools, they lack the practicality and reliability of POLST forms and electronic registries, which have proven to greatly increase the likelihood that the care preferences of seriously ill patients are honored with dignity (Spillers & Lamb, 2011; Tark et al., 2021). Unfortunately, Florida has yet to adopt such legislation. This gap continues to result in situations like the one involving my friend’s father, where a patient’s wishes were not honored.
The shortcomings of these existing forms highlight the urgent need for Florida legislation to support the PDMO form and the development of an accompanying electronic registry. Creating an electronic registry will help ensure that patient wishes are honored. First responders and other healthcare professionals can access this document securely online before arriving on the scene or at their facility (Duncan et al., 2013).
Over the years, numerous attempts to pass bills supporting such measures have failed to gain traction in Florida’s legislative committees (Kapp, 2016). This year, however, we aim to build grassroots support and finally succeed in enacting this critical legislation. Please contact your local legislator to voice your support for this important healthcare initiative. Share information about these new bills with your colleagues, friends, and family, and encourage them to contact their legislators as well. Phone calls, emails, and letters can significantly impact the likelihood of these bills advancing through legislative committees.
By supporting the PDMO legislation, we can create a more compassionate healthcare system that respects the dignity and wishes of every patient. Your voice matters—reach out to your legislator today and help make a difference. Current information regarding this legislation can be found on author Hattie Bryant’s blog at: https://www.authorhattiebryant.com/post/florida-needs-the-patient-directed-medical-order-law.
About the Author: Meredith Fischer has over 27 years of nursing experience. She has specialized in intensive care and currently cares for patients in a hospice setting. A 1997 graduate of Florida State University, she is currently pursuing her Doctor of Nursing Practice-Family Nurse Practitioner degree at the University of Florida.
References
Duncan, J., Taillac, P., Nangle, B., Henry, M., Houston, J., Talebreza, S., Finch, L., Brunker, C., Rajeev, D., Smith, H. J., & North, C. (2013). Electronic end-of-life care registry: The Utah ePOLST initiative. American
Medical Informatics Association Annual Symposium Proceedings, 2013, 345-353. https://pubmed.ncbi.nlm.nih.gov/24551342/
Kapp, M. B. (2016). Overcoming legal impediments to physician orders for life-sustaining treatment. American Medical Association Journal of Ethics, 18(9), 861 868. https://doi.org/10.1001/journalofethics.2016.18.9.peer1-1609
National POLST. (2022). Honoring the wishes of those with serious illness and frailty. https://polst.org/
Spillers, S. C. & Lamb, B. (2011). Is the POLST model desirable for Florida? Florida
Public Health Review, 8(15), 80-90. https://digitalcommons.unf.edu/fphr/vol8/iss1/15/
Tark, A., Agarwal, M., Dick, A. W., Song, J., & Stone, P. W. (2021). Impact of the Physician Orders for Life-Sustaining Treatment (POLST) program maturity status on the nursing home resident’s place of death. American Journal of Hospice and Palliative Care, 38(7), 812 822. https://doi.org/10.1177/1049909120956650
