Use of the Physician Orders for Scope of Treatment Program in Indiana Nursing Homes

Abstract

Objectives: To assess the use of the Indiana Physician Orders for Scope of Treatment (POST) form to record nursing home (NH) resident treatment preferences and associated practices.

Design: Survey.

Setting: Indiana NHs.

Participants: Staff responsible for advance care planning in 535 NHs.

Measurements: Survey about use of the Indiana POST, related policies, and educational activities.

Methods: NHs were contacted by telephone or email. Nonresponders were sent a brief postcard survey.

Results: Ninety-one percent (n=486) of Indiana NHs participated, and 79% had experience with POST. Of the 65% of NHs that complete POST with residents, 46% reported that half or more residents had a POST form. POST was most often completed at the time of admission (68%). Only 52% of participants were aware of an existing facility policy regarding use of POST; 80% reported general staff education on POST. In the 172 NHs not using POST, reasons for not using it included unfamiliarity with the tool (23%) and lack of facility policies (21%).

Conclusion: Almost 3 years after a grassroots campaign to introduce the voluntary Indiana POST program, a majority of NHs were using POST to support resident care. Areas for improvement include creating policies on POST for all NHs, training staff on POST conversations, and considering processes that may enhance the POST conversation, such as finding an optimal time to engage in conversations about treatment preferences other than a potentially rushed admission process.

Keywords: advance care planning; nursing home; palliative care.