Dr. Barbara Carroll

Dr. Barbara Carroll (Baltimore Sun / August 6, 2013)

How far would you want doctors to go to save your life after a bad accident? It's a tough question many people may not want to think about it, but they should. The state has created the Maryland Order for Life Sustaining Treatment form, which patients fill out as a guideline for how doctors should proceed. Dr. Barbara Carroll, the medical director at Broadmead senior living community in Cockeysville, talks about the new form and how it is different from living wills and other directives.

What is the Maryland Order for Life Sustaining Treatment form?

The Maryland Order for Life Sustaining Treatment (MOLST) form contains physician's or nurse practitioner's orders designating a patient's wishes regarding CPR (cardiopulmonary resuscitation) and other life-sustaining treatments such as ventilators, feeding tubes, blood transfusions, dialysis and others. This differs from the living will, which is signed by the patient and is not a physician's order. Nursing homes and other health care facilities/programs are required to offer it to patients when they are admitted, and it accompanies the patient from one facility to another. The receiving institution is required to honor the form and should review it on admission and when there has been a change in the patient's condition.

How is it different from the Do Not Resuscitate form?

The old Do Not Resuscitate form was developed for the use of paramedics and was only valid in the patient's home and for the ambulance ride to or from the hospital. It was not a physician's order, so was not valid once the patient arrived in the ER.

Why did the state replace the Do Not Resuscitate form with the Maryland Order for Life Sustaining Treatment form?

The MOLST form allows for decisions about other life-sustaining treatments in addition to CPR, and ensures that those orders are honored in all health care settings. ... By having a uniform and universally recognized standard order form, it is more likely that a patient's wishes for their care will be carried out.

What information does the Maryland form include?

It documents who the physician or nurse practitioner spoke to in order to fill out the form; it allows for time-limited trials for ventilators, IV fluids feeding tubes and dialysis; it includes the physician's signature, phone number and license number. If the patient does not want to complete this form, there is an option to indicate that he/she declines to discuss or is unable to make a decision about life-sustaining treatments. In most cases, this would mean that all treatments, including CPR, would be given.

Who should use the form?

Any patient who is in a health care facility (i.e. nursing home, assisted-living facility or hospital) with a serious illness or chronic condition should have this form completed. However, anyone who wants to ensure that their wishes for health care treatments are honored should complete an advance directive while they are of sound mind, and they can ask their physician to complete the MOLST form at any time.

How do patients use the form?

This form allows a patient to make choices for treatment in their current condition, whereas their living will covers what they want in an end-stage or terminal condition, or persistent vegetative state. A physician or nurse practitioner fills out the form after having an informed discussion with the patient about the options. The doctor or nurse practitioner signs it and gives the patient a copy to keep with them. At Broadmead, we encourage even our independent residents to complete the form, which we then keep in their electronic chart. If they do not want CPR, we encourage them to wear a Medic Alert bracelet that states this. We also tell them to give their children or health care agent a copy and have a conversation with them to clarify their wishes. The form can be found at: http://www.marylandmolst.org.

andrea.walker@baltsun.com

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