For Long-Term Care and Skilled Nursing
Clinicians and Facilities
State and federal statutes protect the rights of every adult to make their own health care decisions, including what treatments to accept, decline, or discontinue. In Alaska, the Alaska Health Care Decisions Act (AHCDA) is the statute that governs our Advance Directive (AD) laws and Do Not Resuscitate (DNR) statewide protocols. Alaska POLST is now replacing the Alaska Comfort One program and is a legal medical order indicating the patient’s preferences for emergency and/or life-sustaining treatments when seriously ill or at the end of life.
The Alaska POLST form was signed into regulation May 2021 and may now be used. The orders on a POLST are required to be honored by all health care professionals. To provide for a smooth transition, the Comfort One will also remain a legal medical order, the most recently signed form is the active medical order. DHSS will continue to resupply Comfort One forms until June 1, 2022 to allow health care professionals and institutions to have time to learn about and adopt the Alaska POLST form.
This site is developed and maintained in collaboration with DHSS, ASHNHA, and the members of the Alaska State POLST workgroups to provide the POLST form and resources to support its use and implementation. Future planned resources include an archive of webinar recordings for education and training, a policy share for facilities, and a best practice guide. Check back soon for updated content!
Overview of the Comfort One to POLST Transition:
Clinicians and institutions are starting work now to adapt their practice and policies to using Alaska POLST, while continuing to recognize and honor the Comfort One form.
New Comfort One forms can still be completed, to allow time for POLST adoption. Comfort One forms will no longer be resupplied by the state EMS office after June 1, 2022.
Comfort One forms will continue to be honored and the most recently signed Comfort One or POLST order is the legal medical order.
Patients can be given the opportunity to voluntarily update their Comfort One form to the Alaska POLST form, if POLST better communicates their wishes.
Initial communication in the POLST roll out advised that we should not fax AK POLST forms—feedback has been reviewed and DHSS does now support POLST forms to be faxed, in a HIPPA-compliant manner, to patient’s local EMS/dispatch when the form indicates DNR.
How does the Alaska POLST form affect the Alaska MOST form?
It is recommended that clinicians and health care facilities transition from MOST to AK POLST, too. The Alaska MOST form was developed to address the deficiencies of the Comfort One (needing a way to document pre-arrest life-sustaining treatment preferences.) However, the form was never legislated as a state-wide medical order so there are no protocols instructing health care professionals to follow the MOST orders and no provisions for immunity from civil and criminal liability for health care professionals following the order. For clinicians and facilities that are utilizing the MOST form, it is recommended to transition to using the AK POLST form instead.
How does POLST relate to in-facility orders for code status and life-sustaining treatments?
It will be important for Long Term Care and Skilled Nursing Facilities to offer the Alaska POLST form for any resident with advanced illness, terminal illness, frailty, or permanent unconsciousness that wishes (or with consent/assent from their legal health care decision maker) to put in place a DNR order and +/- other limitations on life-supporting treatments.
A facility can adopt to use the Alaska POLST form as their in-facility orders or can develop a protocol to have this form used in addition to their in-facility orders, assuring the in-facility and state-legislated POLST orders are congruent and simultaneously updated or voided as preferences change.
Resources for clinicians and healthcare administrators:
Webinars and Training:
There are three upcoming free webinars scheduled to provide an overview of the basics of the POLST and to answer questions on its use in skilled nursing facilities and hospitals. Check back for additional events as they become available.
Palliative Care ECHO
1st Tuesday of the Month: March 1, April 5, May 3 | 12:00 pm-1:00 pm
Join the UAA CHD ECHO Project's Palliative Care ECHO for a special three part series on POLST. Starting monthly in March, a team of subject matter experts and guest speakers will explore critical aspects of Alaska's transition from Comfort One to POLST, providing resources, reviewing skills, and supporting our interdisciplinary participant body in an open forum for discussion.
Who should join?
Clinicians, health care administrators, EMS professionals, Long-Term Care and Skilled Nursing clinicians and facilities administrators, and all Alaskan healthcare disciplines supporting patients with serious illness.
March 1: Boot Camp for POLST Transition: Review of Basics with Ursula McVeigh, MD
April 5: The POLST Conversation: Communication skills and the art of language with Sharmon Figenshaw, NP
May 3: POLST and Cultural Considerations with Chris Piromalli, MD
> Register here
RECORDINGS OF PAST EVENTS:
POLST Basics for SNFs - recorded Jan. 12, 2022
This webinar focuses on the basics of the POLST and the change from Comfort One to POLST for the Skilled Nursing Facility audience: SNF Medical Directors, clinicians, and administrators.
Transition from Comfort One to POLST for Hospitals/ER Depts - recorded Jan. 25, 2022
This webinar focuses on providing hospital and emergency department clinicians and policymakers with information about the transition from Comfort One to POLST.
The Art of the POLST in SNFs - recorded Feb. 8, 2022
This webinar focuses on the art of the POLST and providing training in goals of care / serious illness conversations and use of POLST in Skilled Nursing Facilities: how to initiate POLST conversations and translate them into orders.
> Watch the Recording
> Download the Slides
POLST for EMS Echo - January, 2022
Advance Care Planning - Alaska POLST Replacing Comfort One
Part of the ANTHC Tribal Health Webinar series, this webinar provides an overview of the transition from Comfort One to Alaska POLST.