WyoPOLST Goes Into Effect In 2016

CHEYENNE  –  Wyoming physicians and patients received an important tool for end-of-life care as WyoPOLST became law in 2016. The Wyoming Department of Health filed the rules for WyoPOLST with the Secretary of State’s office on April 12.

POLST stands for Providers Orders for Life Sustaining Treatment and seeks to improve end-of-life care in Wyoming by honoring the health care wishes of those who have irreversible conditions and whose life expectancy is less than one year, or who are frail and elderly. This two-page document is completed by a patient in the last year of their life with the assistance of their provider. When completed and signed by a provider, the WyoPOLST constitutes a medical order which is transferrable from facility-to-facility and provider-to-provider throughout the state.

“Before we had POLST, we didn’t have a uniform way of documenting what patients wanted at the end of life. Now we have a form that helps frame the discussion,” says Cheyenne physician Kristina Stefka, M.D.

The form itself is a one-page form where patients explain their interest in various forms of treatment, such as their interest in receiving CPR, and a full range of other treatments such as long-term artificial nutrition, ventilation or other treatments.

WyoPOLST comes from of a working group of Wyoming physicians, physician PT representatives and other stakeholders who brought the concept to the state and began a pilot project in 2014. In 2015, the Wyoming State Legislature passed HB 0162, allowing for the enactment of law to standardize a state POLST form and allow its use with true provider immunity. The document is completely voluntary for patients to use. The WyoPOLST form allows patients to choose and clearly state their own preferences for medical treatment when faced with a life-limiting illness or disease process. Wyoming law now requires that WyoPOLST orders be followed until a review is completed by the accepting health care professional. The law allows for reciprocity so that an order signed at an outside facility is considered valid at any other facility in the state. The law allows that health care providers who honor WyoPOLST documents are not subject to criminal prosecution, civil liability or any other sanction as a result of following the orders.

The WyoPOLST document is complementary to an advance directive, or living will. An advance directive provides instructions specifying what kind of treatment should be given to a person when that individual is no longer able to make those kinds of decisions for him/herself, and it is very restrictive as it only goes into effect if the person has lost decision-making abilities and is terminally ill. The WyoPOLST document can be used to translate a living will into a provider order if the patient has a life-limiting condition. The WyoPOLST is not meant to take the place of an advanced directive.

“This is different than an advanced directive because it is a doctor’s order that is actionable within the medical system. It is appropriate for EMS, and it is about the care the patient wants right now, not sometime in the future,” says Casper physician Cynthia Works, M.D.

The WyoPOLST working group formed in 2014 and instituted a pilot program in November 2014.

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