Public Act 154 was signed by the Governor in November 2017. This law establishes the use of Physician Orders for Scope of Treatment in Michigan.
Physician Orders for Scope of Treatment (POST) is a program designed to help health care professionals honor the treatment decisions of their patients. POST improves the quality of patient care and reduces medical errors by creating a system that identifies patients’ wishes regarding medical treatment and communicates and respects them by creating portable medical orders. It is based on the principles of informed consent and allows decision to be made ahead of a crisis.
POST is a part of the National Physician Orders for Life Sustaining Treatment (POLST) Paradigm.
POST is a tool for translating patient’s goals of care into medical orders so that they are easily located and portable across care settings. POST is not just a specific set of medical orders documented on a form; it is also an approach to end-of-life planning based on conversations between patients, loved ones, and medical professionals.
The POST Program is designed to ensure that seriously ill patients can choose the treatments they want and that their wishes are honored by medical providers. A key component of the system is thoughtful, facilitated advance care planning conversations between health care professionals and patients and those close to them. Completion of a POST form requires shared decision making between the health care professional signing the form and the patient, or his/her legally authorized health care representative. To complete the POST form, there must be a discussion of the patient’s diagnosis and prognosis; the available treatment options given the current circumstances, including the benefits and burdens of those treatments; and the patient’s goals of care and preferences of treatment. Together, they reach an informed decision about desired treatment, based on the person’s values, beliefs and goals for care. Then, if the patient wishes, his/her health care professional completes and signs a MI-POST form based on the patient’s expressed treatment decisions.
POST is not for everyone; only patients with serious advanced illnesses should have a POST form. For patients where a POST is appropriate, their current health status indicates the need for standing medical orders for emergent or future medical care. The POST form is for seriously ill patients for whom their physicians would not be surprised if they died in the next year. It would be inappropriate to provide a MI-POST to all patients, and completion of a POST form is always voluntary.