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Indiana’s POST Act Creates a Comprehensive Medical Directive

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Monday, July 15, 2013   

INDIANAPOLIS - Sometimes medical decisions are left to family members or emergency personnel who don't know a patient's medical treatment wishes.

According to Dr. Susan Hickman of the Indiana University School of Nursing, a medical ethics researcher, that's why the legislature created the POST Act, with POST standing for Physician Orders for Scope of Treatment. And, she said, it's about more than just resuscitation.

"Do you want to return to the hospital and under what circumstances? Do you want a feeding tube? Do you want antibiotics if you get a life-threatening infection? So, the POST really expands beyond the code status order, in order to cover a much wider range of decisions," the doctor said.

Hickman said the POST order is the property of the patient. Emergency personnel suggest keeping it near prescriptions or on the refrigerator to be taken to the hospital or other medical setting if necessary. The POST order is something that can be updated, or verbally revoked, if circumstances merit.

The doctor said that, without a POST order or other medical directive, emergency personnel do everything possible - and that's not always what the patient wants. She said the POST order was created with certain individuals in mind, such as "people with advanced chronic progressive disease and frailty. People with terminal conditions. So, this gives them an opportunity to consider these issues and decisions in advance of a crisis, to bring their family member into the conversation," she said.

Hickman noted that other medical documents aren't recognized by all agencies, but the POST order will be because it is signed by a physician.

"Emergency medical services, nursing facilities staff" will recognize it, she said. "So, you have a tool that actually allows us to act upon and honor those preferences because it is a physician order."

The doctor cautioned that it may take a while before POST orders are widely used in Indiana, as the POST Act just took effect on July 1.




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