– A Consumer Guide to POLST for Hawai‘i –
POLST (Provider Orders for Life-Sustaining Treatment) is a medical order that gives patients more control over their end-of-life care.
Produced on a distinctive bright green form explained and signed by her/his physician or Advanced Practice Registered Nurse (APRN) and the patient, POLST specifies the type of medical treatment that a patient wishes to receive towards the end of life.
- Link to: POLST Information for Providers (on that webpage you find the PDF of Hawaii’s Official POLST Form that you can download and print)
- Download this Consumer Guide to POLST as a PDF file (2-sided, 1.2MB)
- POLST: Doing it Better is a new free POLST Video (7 Min 22 sec) available from the National POLST office. This excellent short video nicely summarizes the essentials of POLST.
We translated key Kōkua Mau documents in 10 languages.
What is POLST?
Frequently Asked Questions (FAQ):
POLST = Provider Orders for Life-Sustaining Treatment, is your care wishes carried out through:
- Your medical orders, completed by a doctor or an Advanced Practice Registered Nurse (APRN) for your care right now.
- Is followed by health care providers, including Emergency Medical Services, such as Paramedics.
- You use POLST when you have a serious health condition.
- Social workers, nurses and other healthcare professionals can help you fill out your own POLST form, but it MUST be signed by your Physician or APRN in order to be valid.
- POLST contains medical orders indicating what medical care you want or don’t want if you become unable to make the decisions yourself.
- Your doctor or APRN, who is licensed in the State of Hawai‘i (or allowed to practice if from the Military or VA) MUST review and sign the POLST form.
- POLST also requires your signature or that of your Legally Authorized Representative (see below for definition.)
When would I need a POLST form?
- The POLST form is intended for a person who has a chronic debilitating illness or is facing a life limiting disease, such as end-stage lung or heart disease or a terminal cancer.
- The decision to create a POLST should be discussed with each person’s own provider.
The POLST form asks for information about your preferences for medical treatments:
- Whether to attempt cardiopulmonary resuscitation or not (see ‘Questions about CPR’),
- The intensity of medical care you want,
- If you want to be hospitalized and under what conditions, and
- If you want artificial nutrition by feeding tube (see ‘Tube Feeding’ handout)
How do I get a copy of the POLST form?
You or your provider can download a POLST form and instructions for providers. The Kōkua Mau website is the central source for POLST information for Hawai‘i. Most hospitals, nursing homes, home health and hospice providers as well as others in the community also have the form for you, and can provide some assistance in understanding it and filling it out. Please remember that your POLST form must be signed by your doctor or Advanced Practice Registered Nurse (APRN) to be valid.
Does the law require that I complete a POLST?
No. POLST is voluntary and has been available in Hawai‘i since July 2009. However without a POLST, Emergency Medical Services (EMS) or other healthcare providers may be required to attempt to restart your heart and breathing should they stop, even if you do not wish an attempt to be made to resuscitate you, and would prefer to die a natural death.
Where is the POLST form kept?
If you live at home you should keep the original lime green POLST form in a location where it can easily be seen. The ideal place is on your refrigerator where EMS personnel will look for it first. Other visible places could be the back of the bedroom door, on a bedside table, or in your medicine cabinet. If you reside in a long-term facility, your POLST form may be kept in your medical chart along with other medical orders. A copy of your POLST form on white paper is legal.
Does the POLST form need to be signed?
Yes. Your doctor or APRN must sign the form in order for it to be a “Provider Order” that is understood and followed by other health care providers, including EMS personnel. The form also requires the signature of the person for whom the form is being completed or their Power of Attorney for Healthcare or Legally Authorized Representative.
What is a Legally Authorized Representative (LAR)?
This is someone who is able to make decisions for the patient when they are not able to make decisions on their own. A LAR can be 1) an agent designated by the patient through a Power of Attorney for Healthcare, 2) a guardian, 3) a surrogate designated by the patient when the patient is still able to make that decision, or 4) a surrogate designated by consensus of interested persons. If a patient is not able to make decisions on their own, the patient’s primary physician determines that is the case. After that, efforts are made to find all the people who have exhibited special care and concern for the patient and are familiar with the patient’s wishes. Some of these people may include a spouse who is not separated or estranged, parents, and children, but interested persons do not necessarily need to be related by blood or marriage. This group of people select a surrogate decision maker by consensus. This is in accordance with HRS 327E-5.
What decisions can be made by a Legally Authorized Representative?
A Legally Authorized Representative can make all decisions that the patient would make on their own behalf with one exception regarding the surrogate decision maker designated by consensus. This surrogate appointed by consensus in accordance with HRS 327E-5 has limitations placed upon him or her about decisions about withholding or withdrawing artificial nutrition and hydration. The surrogate by consensus can only make the decision to withhold or withdraw artificial nutrition and hydration if two physicians independently certify in the patient’s medical records that the artificial nutrition and hydration only prolongs the act of dying and the patient is highly unlikely to have any neurological response in the future.
If I have a POLST form do I need an Advance Health Care Directive (AHCD) too?
It is highly recommended that you also complete an Advance Health Care Directive, but it is not required. An advance health care directive is the best way to:
- make your wishes for treatment be known, and
- appoint an agent to act as your health care power of attorney in the event you may be are unable to speak for yourself.
The POLST form is not the right tool to appoint your agent for the AHCD, since POLST is a medical order. You may obtain more information about advance directives from your provider or here. The combination of POLST and AHCD gives you the best opportunity to have your wishes followed in the event you cannot speak for yourself.
What if I am no longer able to communicate my wishes and I do not have a POLST?
Through an ACHD, you should appoint a health care power of attorney who can speak on your behalf in case you are no longer able to speak for yourself. Your doctor or APRN can complete the POLST form with your Power of Attorney for Healthcare or Legally Authorized Representative based on their understanding of your wishes.
In what setting is the POLST form used?
completed, signed POLST form is a medical order that will remain with you if you are transported between care settings, regardless of whether you are in the hospital, at home or in a long-term care facility. The POLST form is designed to be used to convey your medical orders to healthcare providers including paramedics who arrive after 9-1-1 has been called.
Why is the POLST Form lime green?
The lime green form is brightly colored so it can easily be found when needed and because it copies clearly on white paper. A plain white copy, completed correctly, and signed by a doctor or APRN is equally legal and valid. It will also be honored by health care providers including EMS personnel.
- Download this Consumer Guide to POLST as a PDF file (2-sided, 1.2 MB)
POLST Information for Providers with a PDF of Hawaii’s official POLST Form
Act 154, the POLST legislation to expand signing privileges to APRNs (Advanced Practice Registered Nurse). It was signed June 30 by the Governor and went into effect on July 1, 2014!! more
As of July 1, 2014 Hawai‘i has a new (and improved) POLST form. The Kōkua Mau website is the central source for POLST information for Hawai‘i. You may download the new POLST form and updated POLST information for providers and consumers here.
While the ‘old’ POLST forms with the word ‘physician orders’ are still valid, we recommend that you only use the new POLST Form after July 1, 2014. It has a new added section E and quite a few wording changes.
Looking for POLST Information for other States besides Hawai‘i?
Hawai‘i was the seventh State to pass a POLST law in 2009.
Please visit POLST.org to see what form of POLST is offered in other States.
Background and Legislation
The ‘comfort care only‘ bracelet or necklace (DNR bracelet) program has been suspended indefinitely in Hawaii. More from the DOH here
- Download a PDF file of Act 154 sigened into law July 1, 2014
- Track House Bill 2052 (Relating to Provider Orders for Life-Sustaining Treatment), or Act 154 from the 2014 legislative session in Hawai‘i
From 2009: POLST or Physician Orders for Life Sustaining Treatment is now law in Hawai‘i as Act 186.
About the legal process of Act 186: On July 16, 2009 POLST introduced as HB1379 HD2 SD2 CD1 became law without the Governor’s signature as Act 186, (Gov. Msg. No. 543). Track the bill
Download the pdf of the (2009) bill, (now Act 186).
Hawaii Revised Statutes Title 19 Health Chapter 327K Physician Orders for Life-Sustaining Treatment.