1. Birkholz, Lorri BSN, RN, CEN

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To the Editor:

Having worked as an emergency department nurse for more than 25 years and currently working as a Hospice Home Care Manager, I appreciated Lyn Rabbetts's thoughtful discussion surrounding end-of-life conversations in "The Challenges Patients Experience in Speaking About Death: A Guide for Home Healthcare and Hospice Clinicians" (February, 2013). Nurses play a key role in promoting advance care planning conversations when patients are diagnosed with an advanced or terminal illness. Historically, advance directives and living wills have been the primary tools used to convey end-of-life decisions.


Since 1991, the Physician Orders for Life-Sustaining Treatment (POLST) has been used to translate patient wishes into physician orders (Center for Ethics in Health Care, n.d.). These orders are to be followed by emergency medical services and emergency department physicians. The POLST form is "more relevant and specific than conventional advance directives" and it results in specific medical orders based on the patient's preferences (Meier & Beresford, 2009, p. 291). The Oregon Health & Science University Center for Ethics in Health Care notes that, unlike a traditional do-not-resuscitate order, the POLST allows the patient or their designee to select life-sustaining measures such as cardiopulmonary resuscitation, antibiotic use, artificial nutrition options, and treatment options for medical intervention. The original POLST format has been modified by various state legislatures over the past 2 decades, which has resulted in some state-specific changes to the document's name, content, and conditions for use. Currently there are 14 states with endorsed POLST programs and another 32 with developing programs (National POLST Paradigm, 2012).


As healthcare professionals, nurses play an important role in educating patients on the use of the POLST form as a means of clarifying the patient's goals for future care when faced with a chronic or terminal illness. Initiating these often difficult conversations allows the patient to make an informed decision about future healthcare choices and by completing the POLST their wishes will be followed should they no longer be able to communicate. To view sample POLST forms, visit


New HIPAA Regulations: What Do They Mean for Family Caregivers?

In January 2013 the Department of Health and Human Services issued new regulations designed to strengthen security around the privacy of health information protected under HIPAA. Nothing in the new regulations affects how family caregivers involved in the patient's care or payment for care can have access to protected health information, unless the patient objects. The new regulations set higher financial penalties for providers, and their subcontractors, who do not take adequate security measures to prevent data from being lost or misused. In the past, several providers have failed to encrypt data or ensure that staff follow security procedures.


-Lorri Birkholz, BSN, RN, CEN


Pittsburgh, PA




Center for Ethics in Health Care (n.d.). Physician orders for life-sustaining treatment (POLST). Portland, OR: Oregon Health & Science University.


Meier D. E., Beresford L. (2009). POLST offers next stage in honoring patient preferences. Journal of Palliative Medicine, 12(4), 291-295. [Context Link]


National POLST Paradigm. (2012). About the national POLST paradigm. Retrieved from[Context Link]