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Sunday, July 18, 2010

MOLST (pt. 2)

This is a New York State MOLST form:

The original copies are always pink, but photocopies of the original can also be acceptable. The patient keeps a copy and the doctor who signed off on the form with them also keeps a copy. Patients are advised to keep a copy taped on their fridge or folded in their wallet. Nursing home patients should have their copy in their medical chart at the facility.

MOLST can be used for both pre-hospital and hospital care. I'm sure there's a little more legal discussion involved, but I know the basics in what I look for when I need to make decisions on scene.

The first part discusses CPR, and the patient can choose yes or no. Make sure this is signed by a doctor, the patient (or the patient's HCP), and 1 witness. It's no good without those pretty squiggly lines.

The next part (and this is where it improves on the traditional DNR form), gives the patient three basic choices for "Life Sustaining Treatment":

Comfort measures only: Comfort measures are medical care and treatment provided with the primary goal of relieving pain and other symptoms and reducing suffering. Reasonable measures will be made to offer food and fluids by mouth. Medication, turning in bed, wound care and other measures will be used to relieve pain and suffering. Oxygen, suctioning and manual treatment of airway obstruction will be used as needed for comfort.

Limited medical interventions: The patient will receive medication by mouth or through a vein, heart monitoring and all other necessary treatment, based on MOLST orders.

No limitations on medical interventions: The patient will receive all needed treatments.

The patient goes on to specify whether they want to be intubated or not, and for how long using which kind of machines. They can state whether or not they want to be transported to the hospital for further care. They can state if they want a feeding tube, a trial period with a feeding tube, or no tube at all. They can choose how aggressively antibiotics will be used in their treatment.

And then there's a little space at the end for the patient to write in whatever else they may or may not want to be used in their treatment, such as dialysis or blood transfusions.

Again, be careful with your squiggly lines at the bottom of this second part. You need the doctor, the patient (or HCP), and 2 witnesses.

There's a great online traning program for New York State EMS providers here.

And you can find more information here:

Medical Orders for Life Sustaining Treatment - NYS DOH

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