Medical Orders for Scope of Treatment (MOST)
A new tool for documenting treatment preferences that isStandardized • Efficient • Portable • Flexible • Updatable • Effective
Draft of the MOST form
IMPORTANT: In Colorado, the Medical Orders for Scope of Treatment program is in development; pilot programs in volunteer facilities are underway in selected communities and will be expanded in 2010. We expect to roll out the program statewide in 2010. Legislation is planned for the 2010 session to fully establish the MOST program in the state. Until then, health care professionals and facilities are asked NOT to use the form or initiate the program outside of the pilots. To participate in the statewide roll-out, please contact Colorado Advance Directives Consortium, via Dr. David Koets (chair): dkoets@aol.com).
The Medical Orders for Scope of Treatment form is a 1-page, 2-sided document that consolidates and summarizes patient preferences for key life-sustaining treatments including: CPR, general scope of treatment, antibiotics, artificial nutrition & hydration.
On the form, individuals may refuse treatment, request full treatment, or specify limitations.
The standardized form can be easily and quickly understood by patients, health care providers, and emergency personnel.
It is primarily intended to be used by the chronically or seriously ill person in frequent contact with health care providers, or already residing in a nursing facility.
The Medical Orders for Scope of Treatment is completed by the patient or authorized agent in conversation with a health care provider, then signed by the patient/agent and a physician, advanced practice nurse, or physician’s assistant. The physician/APN/PA signature translates patient preferences into medical orders.
The Medical Orders for Scope of Treatment “travels” with the patient and is honored in any setting: hospital, clinic, day surgery, long-term care facility, ALR, hospice, or at home. The original is brightly colored for easy identification, but photocopies, faxes, and electronic scans are also valid.
The portability of the form allows seamless documentation of treatment preferences and closes gaps as patients transfer from setting to setting or experience delays in access to providers.
The latitude of authorized signers (physician/APN/PA) allows prompt documentation of preferences in rural regions or areas where physicians and health care services are limited.
Treatment preferences may be previously or more extensively documented in the patient’s advance directives. Completion of Medical Orders for Scope of Treatment does not replace or invalidate prior directives. The Medical Orders for Scope of Treatment overrules prior instructions only when they directly conflict.
A section on the back prompts patients and providers to regularly review, confirm, or update choices based on changing conditions.
The Medical Orders for Scope of Treatment is a variant of the Physician’s Orders for Life-Sustaining Treatment, pioneered in Oregon in the late 1990s. Similar programs are now officially sanctioned in Oregon, Washington, West Virginia, New York, California, South Carolina, Tenessee, and parts of Wisconsin. Programs are being developed in 16 states including Colorado, and parts of 8 others.
Extensive research indicates that the Medical Orders for Scope of Treatment program greatly improves incidence of advance care planning and adherence to expressed wishes. (See the POLST Web site, www.polst.org for references and research findings.)
The Medical Orders for Scope of Treatment program in Colorado has been spearheaded by the Colorado Advance Directives Consortium, a multidisciplinary volunteer group including representatives from health care (hospital, hospice, long-term care), professional associations and statewide organizations (Colorado Medical Society, Colorado Bar Association, Colorado Center for Hospice & Palliative Care, Colorado Health Care Association, Colorado Hospital Association) government and social services (CDPHE, EMS, ombudsman, DRCOG, HCPF, legislators), health care ethics, elder law attorneys, and others.
The Consortium has been examining the feasibility of the Medical Orders for Scope of Treatment for Colorado, customizing the form for adherence to Colorado law and medical practice, and seeking input from stakeholders since summer of 2006. A CDPHE taskforce is looking at the Medical Orders for Scope of Treatment in conjunction with their review of the CPR regulations.
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For additional information, please contact:
Colorado Advance Directives Consortium
David Koets, MD, Chair
dkoetsmd@q.com