What is MOLST (Medical Order for Life Support)?
Respecting patient preferences is a critical element in providing quality end-of-life care. Physician Orders for Life Sustaining Treatment (MOLST) is a program to improve the quality of care patients receive at the end of life by translating patients' treatment goals and preferences into physician orders. MOLST relies on communication between the patient, their physician or other designated surrogate decision maker, and healthcare professionals to ensure shared and informed medical decision making.
What is the MOLST DOH-5003 form?
To help physicians and other health professionals discuss and communicate a patient's wishes regarding cardiopulmonary resuscitation (CPR) and other life-sustaining treatments, the Department of Health has approved the DOH-5003 MOLST Physician or Nurse Requisition Form , which can be used by healthcare professionals and institutions nationwide.
The MOLST form is a light pink medical application form signed by a licensed New York state physician, nurse practitioner, or border state physician notifying others of the patient's medical orders for life support treatment. All healthcare professionals must follow these doctor's orders when transferring a patient from one location to another, unless a doctor or nurse examines the patient, reviews and changes the orders.
The MOLST serves as a single document containing the patient's goals and preferences regarding:
- Instructions for resuscitation if the patient has no pulse and/or is not breathing
- Instructions for intubation and mechanical ventilation if the patient has a pulse and is breathing
- treatment guidelines
- Future hospitalization and transfer
- Artificially administered fluids and food
- Antibiotics
- Other treatment instructions not listed
The MOLST form is, under state law, the only form authorized in the state of New York for documenting out-of-hospital, non-resuscitated (DNR) and non-intubated (DNI) orders. In addition, the form is beneficial for patients and healthcare professionals as it contains specific medical instructions and is recognized and used in various healthcare institutions.
Can the MOLST DOH-5003 form be modified if the patient or doctor does not like the form?
Not.NYSDOH updated the form in June 2010 to make it more user-friendly and to align it with the Family Health Care Decisions Act (FHCDA) and other provisions of Chapter 8 of the Articles of Association of 2010, which became effective June 1, 2010 are.
However, Section E under "Additional Instructions" may include additional guidelines for withholding/discontinuing treatment not listed elsewhere on the form, including, for example, decisions about dialysis, implantable defibrillators, and duration of treatment.
What is the difference between a Power of Attorney or Living Will and the MOLST form?
Health care power of attorney and living will are classic living wills for adults over the age of 18. These documents are completed when a patient is able to do so and apply only if the ability to make medical decisions is lost.
The Life Supporting Treatment Physician Orders (MOLST) program was created to complement the use of traditional advance directives and to facilitate the transmission of medical orders related to the care of patients with advanced chronic or serious end-of-life conditions. MOLST contains specific, actionable physician orders that guide the patient through medical environments. Health powers of attorney and living wills often contain more general instructions and cannot be followed by emergency services in an emergency.
Unlike a Health Power of Attorney, the MOLST applies once the patient agrees to the instructions it contains and is signed by a doctor or nurse. It is not a requirement that a patient has lost the ability to make medical decisions. The MOLST program is based on the belief that patients have the right to make their own medical decisions, including decisions about life-sustaining treatments, to communicate those wishes to healthcare providers, and to receive reassuring attention while the wishes are met.
Is the MOLST DOH-5003 form approved for adult patients and minor patients?
The Department of Health has approved a DOH-5003 MOLST Physician or Nurse Claim Form for use with adult patients and minor patients. MOLST can be used by healthcare professionals and facilities nationwide.
NYSDOH has created separate instructions for completing the MOLST form with adult and minor patients respectively. The “General Instructions” and the “Adult Patient Legal Requirements Checklist” are intended to assist healthcare professionals in completing the MOLST form with adult patients and/or their authorized healthcare decision makers. and can be found underhttp://www.health.ny.gov/professionals/patients/patient_rights/molst/.
NYSDOH has also created a “Legal Requirements Checklist for Underage Patients” with instructions to assist healthcare professionals in completing the MOLST form with underage patients and their parents or other guardians with healthcare decision-making authority on their behalf. The checklist for smaller patients can be found at:http://www.health.ny.gov/professionals/patients/patient_rights/molst/docs/checklist_minor.pdf. . . . . . . . . . . . . . . . (PDF, 71 KB, 7 pages.)
Is DOH-5003 MOLST approved for people with developmental disabilities or people with mental illnesses?
The DOH-5003 MOLST form has been approved by the Office of Mental Health (OMH) and the Office for People with Developmental Disabilities (OPWDD) for use as an out-of-hospital DNR/DNI form for persons with developmental disabilities or persons with mental illness. including persons who are unable to make their own health decisions or who are responsible for the appointed person under Article 81 of the Mental Health Act or Article 17-A of the Rules of Procedure of the Alternative Court.
The DOH-5003 MOLST must be completed using the OPWDD-approved checklist, and the checklist MUST be attached to the MOLST form if the form is being used for an individual with a developmental disability who is unable to make their own health care decisions . or a supervisor of in the form of Art. 81 of the Code of Mental Hygiene or Art. 17-A of the Replacement Judgment Procedure Act. The OPWDD checklist can be found at:http://www.opwdd.ny.gov/opwdd_resources/information_for_clinicians/MOLST?.
How to complete a MOLST form for a person with a developmental disability who is unable to make medical decisions or have a guardian of the person designated in Section 81 of the Mental Hygiene Act or Section 17-A of the Substitute Procedures Act ? ?
On January 21, 2011, the Office for People with Developmental Disabilities (OPWDD) approved the use of the MOLST formhttp://www.health.ny.gov/professionals/patients/patient_rights/molst/for people supported in the OPWDD system. However, it must be attached to the MOLST formMOLST Checklist of Legal Requirements for People with Developmental Disabilities.
This means that the MOLST form can only be completed after Probate Procedure Act Section 1750-b has been completed for an individual. Use of the checklist ensures that the relevant legal standards are met before using the MOLST procedure. Note that using the MOLST form is optional.
The most significant change resulting from the OPWDD's approval of the MOLST form relates to non-resuscitated out-of-hospital (DNR) orders. Previously, such DNR orders were required on Form DOH-3474http://www.health.ny.gov/forms/doh–3474.pdf(PDF, 10 KB, 1 p.). An off-hospital DNR order can now be written on Form DOH-3474 or Form MOLST (DOH-5003).
The advantage of the MOLST form is that it can be transferred to other settings during care transitions. Consequently, a DNR issued on a MOLST form is effective in hospitals, nursing homes, nursing homes and community facilities.
What type of adult patient should have a MOLST form?
MOLST is usually intended for patients with serious health problems. Physicians or healthcare professionals should consider consulting with the patient about completing a MOLST form if the patient:
- You want to avoid or receive life-sustaining treatment.
- You live in a care facility or need care services.
- Maybe he'll die next year.
Patients with serious health problems typically include patients with advanced chronic progressive disease and/or frailty (significant weakness and extreme difficulty in self-care activities) and patients who may die or lose the ability to make medical decisions within the next year . MOLST may also be appropriate for older patients who wish to better define their care preferences.
These patients can:
- Wantatappropriate treatment, including cardiopulmonary resuscitation (CPR).
- I want to avoidatlife support treatment.
- ChooseBorderlife support treatment.
- You want to prevent all attempts to induce CPR and prefer to allow death from natural causes (DNR order)
- You want to avoid running a tube down your throat into your windpipe that's attached to a ventilator (intubation) and requesting a "Do Not Intubate Order" (DNI order).
How to fill out a MOLST form for an adult patient?
The MOLST form must be completed based on the current medical condition, values, desires and informed consent of the patient or their authorized decision maker.
Completion of the MOLST begins with an interview or series of interviews between the patient, the healthcare provider or surrogate, and a trained and qualified healthcare professional that defines the patient's care goals, possible treatment options, and reviews the overall treatment. MOLST and ensures informed and shared medical decision-making. The interview must be documented in the medical record. MOLST orders cannot be issued without the consent of the patient or another medical decision-maker, except for patients listed in Checklist #4 (for adult patients in hospitals, nursing homes, or nursing homes who do not make medical decisions and do not have a health plan have that is a proxy or surrogate for public health law).
Although the discussion(s) of treatment goals and options can be initiated by any trained and qualified healthcare professional, a licensed physician or nurse should always at least: (i) consult the patient and/or treating patient or surrogate regarding the diagnosis, Prognosis, treatment goals, treatment preferences and patient approval by the appropriate decision maker and (ii) signing of any orders derived from this discussion. If the doctor is licensed in a border state, the doctor must enter the abbreviation of the state in which he is licensed along with the license number.
What part of the form needs to be completed for an adult patient?
It is strongly recommended that you fill out the first and second pages of the MOLST form. However, the patient or decision maker (i.e., a healthcare provider or surrogate) may not be physically or emotionally ready to make a decision about each treatment option on the form in a single meeting.
Only page 1 of the MOLST form (via CPR/DNR) can be completed and page 2 (Section E) can be completed at another time.
If a patient or decision maker is able to make a decision about one or more treatment options but not others, the physician or nurse should delete on page 2 the portion of the form with the option(s) option(s) for which it is there are one or more options, there is no decision, and write “Decision Deferred” next to those treatment options. If the patient or decision-maker later makes a decision about these treatment option(s), a new form must be completed and signed by a doctor or nurse that includes all of the patient's or patient's views. decisions
The department has developed regulatory requirement checklists to assist providers in completing forms with patients and/or their authorized medical decision makers in various situations. Checklists are available at:http://www.health.ny.gov/professionals/patients/patient_rights/molst/.
Who can complete a MOLST form with the adult patient or healthcare worker?
Completion of the MOLST begins with an interview or series of interviews between the patient, the healthcare provider or surrogate, and a trained and qualified healthcare professional that defines the patient's care goals, possible treatment options, and reviews the overall treatment. MOLST and ensures informed and shared medical decision-making. The interview must be documented in the medical record.
Although the discussion(s) of treatment goals and options can be initiated by any trained and qualified healthcare professional, a licensed physician or nurse should always at least: (i) consult the patient and/or treating patient or surrogate regarding the diagnosis, Prognosis, treatment goals, treatment preferences and patient approval by the appropriate decision maker and (ii) signing of any orders derived from this discussion. If the doctor is licensed in a border state, the doctor must enter the abbreviation of the state in which he is licensed along with the license number.
Conversations between the health worker and the patient should be shared with the health worker and family to ensure that the health worker and family are aware of the patient's wishes and avoid future conflicts.
Can a doctor licensed in another state complete and sign a MOLST?
Physicians licensed in a border state can sign a MOLST form. The physician must enter the abbreviation of the state in which he is licensed along with the license number.
Who approves MOLST prescriptions for adult patients?
MOLST orders must be approved by the patient or other medical decision-maker (a healthcare professional or Public Health Act representative if the patient is unable to make medical decisions about life-sustaining treatment), except for covered patients. according to checklist no. 4 (for adult patients in hospitals, nursing homes or nursing homes without medical decision-making authority who have no power of attorney or GVG substitute).
Is verbal consent allowed for MOLST requests?
Sim.Oral consent is acceptable for MOLST orders.
Are the legal requirements of the New York State Public Health Law the same for all medical decision makers for adult patient life support?
Decision standards, procedures, and legal witness requirements for decisions to refuse or withdraw life-sustaining treatment, including DNR, vary depending on who makes the decision and where the decision is made. Consequently, the New York State Department of Health has developed different checklists for different types of decision makers and settings. Checklists are available at:http://www.health.ny.gov/professionals/patients/patient_rights/molst/.
How can providers strictly comply with all legal requirements for completing the MOLST form for adult patients?
In addition to the MOLST form itself, the department has developed checklists of legal requirements. DOH checklists are NOT designed for use with developmentally disabled patients who lack medical decision-making skills or mentally ill patients in a mental health facility.
The checklists are designed to help providers meet the complex regulatory requirements associated with making life-sustaining treatment decisions for all other patients. They are guiding documents and the use of these checklists is not mandatory. However, providers who do not use checklists must use an alternative method to ensure they are in strict compliance with all legal requirements for completing the form, including requirements related to obtaining informed consent for medical orders from the appropriate person who clinical judgments required. to support orders to withhold or discontinue life-sustaining treatment and obtain ethics committee approval and witness approval, as appropriate.
Decision standards, procedures, and legal witness requirements for decisions to refuse or withdraw life-sustaining treatment, including DNR, vary depending on who makes the decision and where the decision is made. Consequently, the New York State Department of Health has developed different checklists for different types of decision makers and settings.
There are 5 different checklists for adult patients:
Checklist No. 1– Adult patients with medical decision-making capacity (any area)
Checklist No. 2- Adult patients without medical decision-making authority who have a health care professional (any setting)
Checklist No. 3– Adult patients in hospitals, hospices or nursing homes without medical decision-making authority, who do not have health care proxy and the decision-maker is a healthcare representative (representative selected from list of representatives)
Checklist No. 4– Adult patients in hospitals, hospices or nursing homes without medical decision-making authority, who do not have power of attorney and for whom there is no representative on the list
Checklist No. 5– Adult patients without medical decision-making authority who do not have health authority and the MOLST form is completed in the community
For more information on general instructions and the MOLST glossary, seehttp://www.health.ny.gov/professionals/patients/patient_rights/molst/docs/general_instructions_and_glossary.pdf. . . . . . . . . . . . . . . . (PDF, 77 KB, 6 pages.)
The Office for People with Developmental Disabilities has developed its own checklist for people with developmental disabilities without medical decision-making authority. For information on the OPWDD checklist, seehttp://www.opwdd.ny.gov/opwdd_resources/information_for_clinicians/MOLST?.
What are the legal requirements for a patient's prior decision to withhold or withdraw life-sustaining treatment to be effective in a hospital, nursing home or hospice if they later lose the ability to make medical decisions?
For a patient's prior decision to withhold or discontinue life-sustaining treatment to be effective in a hospital, nursing home or hospice after he or she has lost medical decision-making capacity, the prior decision must have been made:
- Orally in a hospital, nursing home or hospice, in the presence of two witnesses aged 18 or over, at least one of whom is a health or social worker affiliated with the hospital, nursing home or hospice; any
- Written.
What are the legal requirements for a surrogate physician to complete a MOLST under the FHCDA on behalf of an adult patient without medical decision capacity who has a surrogate physician in any setting?
A health care professional may make medical decisions on behalf of a patient after two doctors agree that the patient is incapable of making medical decisions. Healthcare workers are often empowered to make decisions as if they were the patient. However, sometimes representing the patient limits the powers of the healthcare provider.
Healthcare workers must make decisions in accordance with the patient's wishes, including their religious and moral beliefs. When the patient's wishes are not well known and cannot be determined with reasonable care, the healthcare provider may make decisions in the patient's best interests, other than a decision to withhold or discontinue artificial feeding or hydration. Healthcare professionals are only authorized to make the decision to withhold or discontinue artificial feeding or hydration if they are aware of the patient's desire to have artificial feeding and hydration administered.
For more information on the legal requirements for adult patients without medical decision-making who have a healthcare provider in any setting, seehttp://www.health.ny.gov/professionals/patients/patient_rights/molst/docs/checklist_2.pdf. . . . . . . . . . . . . . . . (PDF, 61 KB, 3 pages.)
What are the legal requirements for a surrogate to complete a MOLST under the FHCDA for adult patients in hospitals, hospices or nursing homes without medical decision-making authority who do not have a health officer and the decision-maker is a lawful public health surrogate? (a surrogate selected from the list of surrogates)?
Under the Family Health Care Decisions Act, a surrogate selected from the list of surrogates can make any type of medical decision in a hospital, hospice, or nursing home after the patient has been deemed legally incompetent. Certain clinical criteria must be met for the decision to withhold or discontinue life-sustaining treatment.
There are specific requirements for refusing artificial feeding and hydration in a hospital on appeal from the attending physician or nurse and for non-DNR decisions in a nursing home when the physician or nurse determines that the patient has an irreversible disease. or incurable condition. In these situations, the ethics review committee of the facility must approve. This nursing home duty does not apply to a decision to withhold or discontinue life support treatment when death is expected within 6 months with or without treatment or when the patient is persistently unconscious.
For more information on legal requirements for patients of legal age in hospitals, nursing homes or care homes without medical authority who do not have a health care proxy and the decision maker is a health care professional (a representative selected from the substitute list), please tickhttp://www.health.ny.gov/professionals/patients/patient_rights/molst/docs/checklist_3.pdf. . . . . . . . . . . . . . . . (PDF, 95 KB, 4 pages.)
How does the provider identify and notify the appropriate public health surrogate under the FHCDA?
The treating physician or nurse will designate and notify a person of the highest priority class who is reasonably available, willing and competent to act as the backup decision maker. That person may nominate anyone else on the list as a replacement, as long as no one in a higher priority class than the nominee objects.
In order of highest priority, the appropriate replacement for the Public Health Act under the FHCDA is:
- Person responsible for the patient, empowered to decide on healthcare, in accordance with Article 81 of the Mental Health Code
- Spouse of the patient, unless legally separated from the patient, or domestic partner
- Patient's son or daughter, over 18 years of age
- patient's father
- Patient's brother or sister, over 18 years of age
- Actively involved close friend of the patient, over 18 years old
This is the list of substitutes for the Public Health Act. There is a separate surrogate list for people with developmental disabilities who lack medical decision-making authority; This list is activeOPWDD-Checkliste🇧🇷 For more information, seeOPWDD Memorandum dated 21 January 2011.
Is "representative" a court-appointed body?
Please askNew York State Bar Association Legal Information Center Frequently Asked Questions.
According to § 81 MHL, “a guardian authorized to make decisions” has the highest priority. Does this include a guardian appointed prior to the FHCDA Effective Date?
Please askNew York State Bar Association Legal Information Center Frequently Asked Questions.
If the top category is adult son or daughter and there is more than one, are they all alternates? If not, who selects the replacement and on what basis?
Please askNew York State Bar Association Legal Information Center Frequently Asked Questions.
And if someone under the surrogate objected to the surrogate's decision, how would the hospital react? For example, would the hospital withdraw treatment from a patient over adult child objections because the domestic partner takes precedence over the adult child?
Please askNew York State Bar Association Legal Information Center Frequently Asked Questions.
The following would be considered brothers or sisters for purposes of the FHCDA surrogate list: Half brother or sister? Half brother or half sister? An adoptive brother or an adoptive sister? Would a full brother or sister take precedence over a half brother or sister?
Please askNew York State Bar Association Legal Information Center Frequently Asked Questions.
Would he be considered a son or daughter: stepson or stepson? Adopted son or adopted daughter?
Please askNew York State Bar Association Legal Information Center Frequently Asked Questions.
What is the Role of the Designated Representative (NYCRR 415.10) in a Nursing Home? Are the designated agent and alternate the same person?
Please askNew York State Bar Association Legal Information Center Frequently Asked Questions.
What are the clinical standards for a surrogate mother's decision to consent to a DNR order?
Under the FHCDA, the physician or nurse and an accompanying physician or nurse must determine with reasonable medical assurance that CPR would be unusually distressing and:
- The patient has an illness or injury that could result in death within six months, regardless of treatment or not;Öthe patient is permanently unconscious and/or
- The provision of any treatment would involve such pain, suffering or other distress that under no circumstances would it reasonably be considered inhuman or exceedingly distressing; and the patient has an irreversible or incurable condition; Y
- The identification of the treating doctor or nursing staff is documented in the medical prescription.
What are the standards for FHCDA proxies to make decisions recorded on a MOLST form under the FHCDA?
Decisions made by an FHCDA proxy under the FHCDA must be consistent with the patient's wishes, including religious and moral beliefs; or when the patient's wishes are not sufficiently known and cannot be determined in the patient's best interest. This includes considering:
- the dignity and uniqueness of each person;
- the possibility and extent of preserving the patient's life;
- maintaining, improving or restoring the health or functioning of the patient;
- the alleviation of the patient's suffering; Y
- any medical conditions and other concerns and values that a reasonable person in the patient's circumstances would wish to consider.
What are the specific requirements under the FHCDA for decisions to refuse or discontinue life-sustaining treatment due to the presence of an "irreversible or incurable condition"?
In hospitals, special requirements apply when artificial feeding and hydration is withdrawn or refused in a hospital due to the objection of the treating doctor or nurse. If the treating physician or nurse disagrees with the order, the ethics review committee (including a physician or nurse not directly responsible for the patient's care) or a court of competent jurisdiction must find that the physician's order is consistent with the order. with the required conditions. the rules
In nursing homes, orders to withhold or discontinue life-sustaining treatment other than DNR orders require the Ethics Review Committee (including at least one doctor or nurse not directly responsible for the patient's care) or a competent court to decide whether the requests will be made meet the required standards.
Who decides and what are the legal requirements for completing a MOLST for adult hospital or nursing home patients without medical decision-making authority, who do not have health care proxy and for whom there is no representation on the representation list?
Under the Family Health Care Decisions Act, a patient in a hospital or nursing home that does not have representation or representation can only be denied life support if a court or two doctors or nurses make the decision. Persons authorized by the facility who agree that even if the patient received the treatment, the patient would die soon and that providing the treatment would violate accepted medical standards.
For more information on legal requirements for adult patients in hospitals, nursing homes or nursing homes without medical decision-making authority, who do not have power of attorney and for whom there is no representation on the representation list, seehttp://www.health.ny.gov/professionals/patients/patient_rights/molst/docs/checklist_4.pdf. . . . . . . . . . . . . . . . (PDF, 58 KB, 4 pages.)
Who decides and what are the legal requirements for performing a MOLST for adult patients without medical decision-making authority who do not have health care proxy and the MOLST is performed in the community?
In the community, the proxies of the Ley de Salud Pública (chosen proxies from the list of proxies) can give their consent to an out-of-hospital DNR prescription or an out-of-hospital DNI prescription on behalf of patients who are unable to do so are making decisions. If MOLST is performed in the community for a patient who does not have a health care authority, the physician or nurse may issue other medical orders to withhold life-sustaining treatment in addition to the DNR and DNI.only whether there is clear and convincing evidence of the patient's willingness to refuse treatment.
If the patient is enrolled in a community-based palliative care program, palliative care plan decisions may be made by proxy without clear and compelling evidence, provided they meet established clinical and patient-centered standards for patient-centered decisions. substitutes described above.
"Clear and compelling evidence" is evidence that the patient had a firm and proven obligation not to receive life-sustaining treatment in circumstances such as the patient's current medical condition. Evidence may consist of a written advance directive and/or previous oral statements indicating the patient's wishes, taking into account the circumstances in which such statements were made and to whom. When deciding whether the patient's will is clear and persuasive, the following should be considered:
- whether the statements were general or specific;
- whether statements relate to specific circumstances (e.g. terminal illness, vegetative state) that are similar to the current medical condition of the patient;
- the intensity, frequency, consistency and seriousness of such statements;
- whether the statements tended to show that in circumstances such as those presented, the patient had a firm and established commitment to certain treatment decisions;
- whether the strength and persistence of the patient's moral and religious beliefs make a renewed change of heart unlikely; Y
- whether statements were made to a single person or to more than one person close to the patient.
For more information on the legal requirements for adult patients without medical decision-making who do not have a health advocate and complete the MOLST form in the community, seehttp://www.health.ny.gov/professionals/patients/patient_rights/molst/docs/checklist_5.pdf. . . . . . . . . . . . . . . . (PDF, 60 KB, 4 pages.)
Is the documentation of the medical record important and part of the process?
Sim.The interview must be documented in the medical record. Healthcare professionals must document the following:
- Interview with the patient, healthcare staff, vice decision maker and “family” as defined by the patient.
- Assessment of patient ability
- Documentation of "clear and compelling" evidence as required
- Documentation of legal requirements based on who made the decision and where the decision was made. These are listed in the NYSDOH Checklist of Regulatory Requirements for Adult and Minor Patients and the OPWDD-MOLST Checklist for Persons with Developmental Disabilities without Medical Decision Capacity.
What is "clear and convincing" evidence?
Decisions in favor of an incapacitated patient in the community require “clear and compelling” evidence in addition to the DNR and/or DNI.
"Clear and compelling evidence" is evidence that the patient had a firm and proven obligation not to receive life-sustaining treatment in circumstances such as the patient's current medical condition. Evidence may consist of a written advance directive and/or previous oral statements indicating the patient's wishes, taking into account the circumstances in which such statements were made and to whom. When deciding whether the patient's will is clear and persuasive, the following should be considered:
- whether the statements were general or specific;
- whether statements relate to specific circumstances (e.g. terminal illness, vegetative state) that are similar to the current medical condition of the patient;
- the intensity, frequency, consistency and seriousness of such statements;
- whether the statements tended to show that in circumstances such as those presented, the patient had a firm and established commitment to certain treatment decisions;
- whether the strength and persistence of the patient's moral and religious beliefs make a renewed change of heart unlikely; Y
- whether statements were made to a single person or to more than one person close to the patient.
What does a doctor or nurse do when there is disagreement about "conclusive and compelling evidence"?
When family members disagree, there are often reasons for the conflict that have nothing to do with the underlying condition. The focus should be on identifying the source of the conflict and then proceeding with a plan to resolve the conflict. Ethics counseling or palliative care may help.
What is capacity?
The Family Health Care Decisions Act (FHCDA) defines “decision making” as the ability to understand and assess the nature and consequences of proposed health care, including benefits and risks and alternatives to health care. Decision. 🇧🇷
Who determines the capacity?
The attending physician determines the capacity. The Health Care Power of Attorney Act currently requires a second doctor to provide co-determination. The FHCDA allows a doctor or nurse to determine capacitance. The FHCDA also requires a concurrent determination of disability, but allows for a concurrent determination by a health or social services professional.
If the treating physician or nurse has determined that the patient's medical incapacity is due to a mental illness, one of the two physicians or nurses who determined the patient's medical incapacity must be a qualified psychiatrist. 🇧🇷
If the treating physician determines that the individual's inability to make health care decisions is due to developmental disabilities, the treating physician, treating physician, or licensed psychologist must: (a) be an employee of a child care agency; developmental disabilities (DDSO); or (b) has been employed for at least 2 years at a facility or program operated, licensed or authorized by OPWDD; or (c) be recognized by the OPWDD officer as having competent training or having 3 years experience in the provision of services to people with developmental disabilities.
Can doctors or nurses determine capacity without physically examining the patient, for example over the phone?
Unlike the previous DNR law, the FHCDA no longer includes a requirement for a “personal examination”. Consequently, the doctor or nurse must meet the applicable standard of professional care. In most cases this would require an in-person examination, but in certain circumstances this may not be the case, e.g. B. when the patient is incapacitated due to unconsciousness or advanced dementia.
Do I need psychiatric advice in any case to determine the ability to make decisions?
Not.The treating doctor or nurse can assess capacity but should consult a qualified psychiatrist if the patient has a mental illness or if there is any doubt about capacity. Any qualified doctor or nurse can determine the capacity.
When do I need psychiatric advice?
If there is reason to believe that the personlack of capacitydue to mental illness, one of the two doctors or nurses who determined that the patient is incapable of judgment must be a qualified psychiatrist. The determination of the qualified psychiatrist is documented in the medical record.
“Qualified Psychiatrist” means a physician licensed to practice medicine in the State of New York, certified or qualified to be certified by the American Board of Psychiatry and Neurology, or certified or eligible to be certified by the American Board of Neurology and Osteopathic Psychiatry by this board.
Mental illness is not related to dementia; includes but is not limited to conditions such as schizophrenia or an acute psychotic episode.
Who determines the performance of people with developmental disabilities?
if the individuallack of capacitybecause of a developmental disability, the consent of a physician or psychologist with experience or special training in the field of developmental disabilities must be obtained. The physician or psychologist must: (a) be employed by an Office of Services for Developmental Disabilities (DDSO); or (b) has been employed for at least 2 years at a facility or program operated, licensed or authorized by OPWDD; or (c) be recognized by the OPWDD officer as having competent training or having 3 years experience in the provision of services to people with developmental disabilities.
What happens to a completed MOLST form?
MOLST forms are designed to travel with the person between care locations.
in a plant
The form must be kept in front of the person's medical record if the person is in a facility.
marry
When the person is at home, the MOLST form should be kept in the refrigerator, near the phone in the kitchen, or on the person's bed. In an emergency, rescue personnel are trained to look for the MOLST form at these locations.
care transitions
A photocopy of the MOLST form must be made if the person is being transferred from one healthcare facility to another (e.g., being admitted from a nursing home to a hospital). The photocopy of the form must be kept in the medical record at the original location at the time of transition of care. The original form must accompany the individual and be placed on the individual's medical record at the new facility.
MOLST forms and any living wills known to have been submitted and their documentationoral advance directivethey must be kept together and handed over with the patient upon discharge.
When should MOLST be reviewed?
The doctor or nurse must review the MOLST form from time to time as required by law and also:
- When the patient moves from one place to another to receive care; any
- If the patient's state of health changes significantly (for better or worse); any
- When the patient or another decision maker changes their mind about the treatment.
Allow DNR/Inherent Death Writs
The Public Health Act requires the doctor or nurse to review ONR prescriptions outside of the hospital and record the review at least every 90 days. In hospitals and nursing homes, MOLST prescriptions must be reviewed regularly according to facility policies.
Life-sustaining treatment prescriptions
A patient's health status, prognosis, values, desires, and treatment goals may change over time. The doctor or nurse must review these orders at the same time as the DNR/Allow Natural Death order and record the review.
How should MOLST applications be reviewed and renewed?
Review all medical orders in Sections A through E of the MOLST form.
Document the result of the check in Section F
- If the patient's medical condition, medical decision-making capacity, or preferences do not change, sign, date, and check the No Changes box.
- If there is a significant change in the patient's medical condition, medical decision-making capacity, care goals, or preferences that will result in a change in MOLST prescriptions, write “INVALID” in capital letters on pages 1 and 2 and fill out a new form from , in accordance with the standards and decision-making processes of the New York State Public Health Act. Check the "FORM CANCELLED, new form filled out" check box. (KEEP the invalid MOLST form in your medical record, medical record, or electronic record as required by law.)
- If this form is voided and no new forms are completed, full care and resuscitation will be provided unless the patient, surrogate, or healthcare provider decides otherwise. On pages 1 and 2, write “VOID” in capital letters and check the box “VOID FORM, no new form”. (KEEP the invalid MOLST form in your medical record, medical record, or electronic record as required by law.)
Can a patient change MOLST prescriptions?
A patient with medical decision-making capacity regarding life-sustaining treatment may withdraw their consent to MOLST prescriptions and ask their doctor or nurse to change them. If the patient is unable to make health care decisions and treatment goals change due to a significant change in health status, the health care worker or proxy may also withdraw consent and request a change to the MOLST. The patient, healthcare provider, or surrogate mother should be consulted about any changes recommended by the patient's doctor. No changes should be made without the informed consent of the patient or the responsible decision maker.
Are MOLST orders legal and valid when moving patients between care facilities?
MOLST orders issued under New York law remain valid when the patient transfers from one healthcare facility to another. Out-of-hospital DNR applications, including those on a MOLST form, must be reviewed by a doctor or nurse at least every 90 days. In addition, all MOLST orders must be reviewed in accordance with institutional policy and when the patient moves between care facilities, when there is a significant change in medical status, and when the patient or other critical medical care decisions change your mind about treatment. 🇧🇷
Why is the MOLST form light pink?
We strongly recommend printing the form on thick, glossy 'Pulsar' pink paper. When emergency responders respond to a community emergency call, they are trained to verify that the patient has a pink MOLST form before life support treatment is instituted. You may not notice a MOLST form on plain white paper. However, blank MOLST forms and photocopies, facsimiles or electronic representations of the signed original MOLST are legal and valid.
How can you keep the pink color of the MOLST form?
If the patient is being transferred between care facilities, a copy of the Pulsar Pink paper form should be made. The original MOLST form must accompany the patient and be kept at the new care facility or placed on the refrigerator at home.
Is a blank copy of the signed original MOLST form legal and valid?
Sim.White MOLST forms and photocopies, faxes or electronic representations of the signed original MOLST are legal and valid.
Is a photocopy of the signed original MOLST form legal and valid?
Sim.White MOLST forms and photocopies, faxes or electronic representations of the signed original MOLST are legal and valid.
Is a facsimile (fax) of the signed original MOLST form legal and valid?
Sim.White MOLST forms and photocopies, faxes or electronic representations of the signed original MOLST are legal and valid.
Is an electronic representation of the signed original MOLST form legal and valid?
Sim.White MOLST forms and photocopies, faxes or electronic representations of the signed original MOLST are legal and valid.
Is the signature on the signed MOLST original form legal and valid?
Not.Stamped signatures are not permitted.
How should a MOLST form be used in an electronic health record facility?
Scan the MOLST on the computer at the time of admission and discharge. Review the MOLST at discharge or care transition and retain an electronic copy. The original pink MOLST form must be given to the patient upon discharge. A copy must be kept on the electronic medical record, a copy must go to the general practitioner or nurse's office, and a copy must go to the home care agency if the patient is being cared for at home.
Is an electronic version of MOLST (eMOLST) available?
As a result of a HEAL 5 (Healthcare Efficiency and Affordability) grant from the New York State Department of Health, a secure web-based application will provide an electronic version of the current New York State Department of Health MOLST 5003 form. York on paper available to providers through the Rochester Regional Health Information Organization (RHIO). Through integration with Rochester RHIO, signed eMOLST forms are attached to the XDS.b dataset.
Consistent with New York State's vision for open systems solutions, the eMOLST application will be developed using open architecture principles for the benefit of the community and other RHIOs across the state. The long-term goal is to develop a New York State MOLST registry that will work with all RHIOs across the state. A mobile app is available to support many eMOLST features.
The eMOLST application documents the clinical process, including goals for discussion of care and regulatory requirements. The eMOLST app updates the workflow for filling out the information required for a statutory medical order with automated user feedback for quality review and missing information notification, as well as user training tools. Prepares a MOLST DOH-5003 form and MOLST Chart Documentation Form for adult or juvenile patients, or an OPWDD checklist for people with developmental disabilities who lack medical decision-making skills.
By moving the MOLST form to an easily accessible electronic format, healthcare providers, including EMS, have access to MOLST forms in all care settings, including hospitals, nursing homes and in the community. This approach allows the emergency services to view it in an emergency and other systems to view it when needed, as the document is shared throughout the care process.
Does the MOLST form replace the classic living will?
Not.A properly completed MOLST form contains legal and valid medical orders. It is not intended to replace classic living wills such as health care powers of attorney and living wills.
Can MOLST replace current DNR forms in healthcare facilities?
Sim.In October 2005, the New York State Department of Health (NYSDOH) approved the Medical Orders for Life Sustaining Treatment (MOLST) physician or nurse order form. English), as a Do Not Resuscitate (DNR) form that can be used in any setting.
On January 11, 2006, NYSDOH sent a letter introducing MOLST to all healthcare facilities in New York State.
NYSDOH updated the MOLST form in June 2010 to make it more user-friendly and to align the form with the Family Health Care Decisions Act (FHCDA) and other provisions of Chapter 8 of the Articles of Incorporation of 2010, which became effective December 1. June 2010.
Where can I get MOLST forms?
MOLST forms can be downloaded from the NYSDOH website athttp://www.health.ny.gov/professionals/patients/patient_rights/molst/Öwww.CompassionYSupport.org.
The MOLST form should be printed on thick glossy pink paper. Printed copies of the pink cardstock form (with all four sides printed horizontally/duplexed on a single 11" x 17" sheet folded in half) can be ordered using a downloadable form athttp://www.compasiónyapoyo.org/.
Where can I get more information about MOLST?
For more information on the MOLST program, visit the Department of Health's website athttp://www.health.ny.gov/professionals/patients/patient_rights/molst/and the Compassion and Support website, MOLST Professionals section and MOLST Training Center atwww.CompassionYSupport.org.