NMC Commentary

Is it Important to Document Health Decisions in Advance?

Yes!  Thinking through in advance how you would like certain medical situations to be handled is very important.  Doing so, and then communicating your wishes using the appropriate processes, helps ensure your wishes are followed.  It also can take the burden of uncertainty off your loved ones.  Each year, NMC and our community partners celebrate National Healthcare Decisions week in order to help bring attention to this important planning.  This year, our focus is on a new form, known as “COLST” – the “Clinician Order for Life Sustaining Care” which has replaced the old “Do Not Resuscitate” form that was used when a patient did not wish to have Cardiopulmonary Resuscitation (CPR).  This is a form that a patient would complete during a conversation with their physician or advanced practice provider (who also signs the form).

The Vermont Ethics Network has a very informative, easy to navigate website (http://www.vtethicsnetwork.org/colst.html) which explains the COLST form. It says, “In the past a Do-Not-Resuscitate Order (DNR) has been used when a patient does not wish to have Cardiopulmonary Resuscitation (CPR). In recent years the ‘old DNR’ order has been incorporated into a new form known as the DNR/COLST order by the Vermont Department of Health.  This more complete document is a clinician order for life-sustaining treatment (COLST) and conveys patients’ wishes for CPR, intubation, transfer to the hospital, antibiotics, artificial nutrition and hydration, as well as overall treatment goals.”

Here are some of the answers to frequently answered questions provided by the Vermont Ethics Network:

“What are the main differences between an Advance Directive and DNR/COLST?  An Advance Directive is completed by the patient, allows for nuances and is not honored in an out of hospital emergency. The DNR/COLST order is completed by a clinician, is black and white and is honored in an out of hospital emergency.”

“Does everyone need a DNR/COLST completed?  No, a DNR/COLST is intended for patients with serious health conditions who: want to express preferences for life-sustaining treatment; and/or reside in a long-term care facility or require long-term care services; and/or have a terminal illness.”

“Is there one specific DNR/COLST form or can each facility use a unique form? An out-of-hospital DNR/COLST shall be issued on the Department of Health’s Vermont DNR/COLST form (http://www.vtethicsnetwork.org/forms/VDH-2017-Clinician-DNR-COLST-Instructions-Form.pdf).  Health care facilities and Residential care facilities may document DNR/COLST orders in the patient’s medical record in a facility specific manner when the patient is in their care.”

“How often should a DNR/COLST be reviewed/updated? The minimum recommended time frame to review and update DNR/COLST is annually. It is recommended that DNR/COLST be reviewed periodically and a new order completed if necessary when: the patient is transferred from one care setting to another; the patient is transferred to a new care level; there is substantial change in the patient’s health status; the patient’s treatment goals and preferences change.

We are fortunate to have a resource like the Vermont Ethics Network to help provide accurate, consistent information on important topics such as life sustaining care. NMC is a financial supporter of their work to help ensure this resource is available to our community. We are also fortunate to have strong access to dedicated physicians and advance practice providers to help inform and guide our care and decision making. I am also grateful for our partners who help ensure our community has the information and resources we all need to make informed decisions in advance, including: Franklin County Home Health Agency; Northwestern Counseling & Support Services; NOTCH (Northern Tier Centers for Health); SASH (Support & Services at Home); Age Well; Franklin County Rehab Center; The Villa; Holiday House; and St. Albans Healthcare & Rehabilitation Center.  The collaboration between partners in our community is key to the continuum of care and we deeply appreciate these partnerships.

Please, talk to your primary care provider about your healthcare wishes and document your intentions appropriately. If you have questions on how to get started, call your primary care office or NMC’s Care Management Team at (802) 524-1097.  Having access to your decisions in advance helps your providers deliver exceptional care within the parameters of your wishes.

— Jill Berry Bowen, NMC’s Chief Executive Officer