FAQ

Frequently Asked Questions (FAQ)
 

What is LaPOST?

The mission of LaPOST is to improve end-of-life care in Louisiana by honoring the health care wishes and goals of care of those with life-limiting illnesses and irreversible conditions.

  • LaPOST stands for Louisiana Physician Order for Scope of Treatment and refers to a PHYSICIAN ORDER that documents and directs a patient’s preferences regarding medical care when faced with life limiting illnesses and irreversible conditions.
  • The LaPOST document is a PHYSICIAN ORDER that transfers with the patient across health care settings.
  • The LaPOST document is a standardized form that is brightly colored (gold) and easily identifiable. (click here to view or print the forms)
  • The LaPOST document must be signed by a physician and by the patient, or if the patient lacks decision-making capacity, the legally recognized personal health care representative.
          The LaPOST document is voluntary.
          The LaPOST model of care is not biased for or against treatment.
          The LaPOST document represents a model program for end-of-life care.
          The LaPOST program was approved by the Louisiana legislature during the 2010 legislative session as ACT 954
 

Who is the LaPOST document most appropriate for?

TheLaPOST document can be completed on a qualified patient regardless of age. It is useful for patients who are seriously ill with “life-limiting disease and irreversible conditions” and whose life expectancy is less than one year or who are frail and elderly. It is used as part of the health care planning process and is complementary with advance directives. The LaPOST document however, may be used in the absence of those documents. The document is completed by the patient (or health care representative) and the physician.

What is an advance directive?

The advance directive is also known as a “living will.” It is a legal document that provides instructions specifying what kind of treatment should be given to a person when the individual is no longer able to make decisions or speak for himself/herself.  It is restrictive, as it only goes into effect if the patient has lost the ability to make decisions and is terminally ill. It is usually completed in advance of any known illness.  It may be very specific or very vague.

The health care power of attorney authorizes someone else to make decisions on behalf of the patient when he/she is no longer able to make decisions or speak for himself/herself. In Louisiana, there is a specific order of who can make these decisions for the incapacitated patient if no written instructions are available. (to view or print the forms, click here)

Is LaPOST an advance directive?

Yes and more. The LaPOST document is a PHYSICIAN ORDER that outlines a patient’s wishes for medical treatment and goals of care. It can also be used to translate a living will into a physician order if the patient has a life-limiting and irreversible condition. The LaPOST document must be discussed with the patient and/or health care representative and appropriately completed. When completed, it must be honored by all health care professionals.

Do you have to have an advance directive to complete a LaPOST document?

No, but the advance directive can complement the LaPOST document.

Can the LaPOST document be completed by someone other than the patient?

TheLaPOST document can be completed by the patient’s personal health care representative if the patient is no longer able to speak for himself/herself. The Personal Health Care representative is defined in R.S. 40:1299.64.2 (9) and means a person who has authority in accordance with Louisiana law to act on behalf of an individual who is an adult or emancipated minor in making decisions related to health care because of incapacity.

What are the requirements for a LaPOST document?

The requirements for the LaPOST document are written in the statute R.S. 40:1299.64.1 through 1299.64.6. The official document can be downloaded and printed on the appropriate colored paper. (click here to download)

Is the LaPOST document reviewed regularly?

The document should be reviewed:

a)      When the patient is transferred from one care setting to another

b)      With any significant change in condition

c)      When the patient’s treatment preferences change

d)     Please see side 2 of LaPOST document.

Can a patient revoke a LaPOST document?

Yes, the patient can revoke a LaPOST document at any time. If the patient no longer has decision making capacity, the personal health care representative may revoke the LaPOST document if there is new knowledge of a change in the patient’s wishes or medical condition. The document must have “VOID” written through sections A through D in large letters. This must be signed and dated.

Can a copy of the LaPOST document, rather than the original transfer with the patient?

Yes, as long as the copy contains the most recent and valid patient’s wishes and is the official document written in statute R.S. 40:1299.64.1 through 1299.64.6. It is recommended that it is also be copied onto the appropriate colored paper whenever possible.

Does the advance directive supersede the LaPOST document?

The most recent expression of the patient’s wishes is honored.

What happens if the two documents are in conflict?

If the LaPOST document conflicts with the patient’s previously expressed health care instructions or advance directive, then, to the extent of the conflict, the most recent expression of the patient’s wishes are honored. A higher level of care is provided until additional information or clarification is received. Ultimately, it is the responsibility of the attending physician to clarify any conflicts with the two documents.

How is this resolved?

If there are any conflicts or ethical concerns about the LaPOST document and orders, then appropriate resources—ethics committees, care conferences, legal, risk management or other administrative and medical resources may be utilized to resolve the conflict.

During the conflict resolution, consideration should always be given to:
  • The attending physician’s assessment of the patient’s current health status and the medical indications for care or treatment;
  • The determination by the physician as to whether the care or treatment specified byLaPOST is medically ineffective, non-beneficial or contrary to generally accepted health care standards; and
  • The patient's most recently expressed preferences for treatment and the patient’s treatment goals.
  • A higher level of care is provided until more information or clarification is received.

Does DNR mean that the patient does not want treatment?

No, Do Not Resuscitate means that no attempts will be made to restart the heart or breathing if the patient is dead and has no pulse or respirations.

Can patients who choose comfort measures only receive treatment such as CPAP or BiPAP?

Yes, if the use of that intervention is for comfort or can restore comfort.

How does the LaPOST program ensure that patients receive the type of care they want?

TheLaPOST document represents the wishes and goals of care of the patient which is translated into a physician order that is readily available to other health care professionals. The patient and the physician must have a conversation from which this information is obtained.

What about patients who are unable to speak for themselves?

TheLaPOST document is completed only after a discussion of end-of-life wishes and goals of care with the patient or personal health care representative and the physician. The personal health care representative or health care agent and the physician are expected to represent the interests of the patient who is unable to speak for himself/herself based on the patient’s previously known wishes.

What does my cultural or religious heritage tell me about end-of-life care?

Cultural and religious heritages vary widely in regards to end-of-life care.  To get more information/resources on cultural and religious practices. (click here)
 
Does the physician have to be licensed in Louisiana since it is "Louisiana Physician Orders for Scope of Treatment"?
 
The physician must be licensed in Louisiana but may not credentialed at your facility. There is currently no process for validating license numbers on the paper LaPOST. The completion of the document is one of good faith. We do not require the physician license number on the document but do require a phone number where the physician can be reached (presumably the office or answering service can verify that doctor works there). As we move to electronic registries and health records this will be less of an issue. 
 
The credentialed  physician in the new setting must follow the orders immediately, but the credentialed physician is obliged to examine, assess, review/sign the orders at the time of the care transition, as health status has presumably changed and goals for care may have changed. This credentialed physician may then issue new orders consistent with the most current information available about the patient’s health status, medical condition, treatment preferences and goals of care. The reasons for any deviation from the LaPOST will be documented in the medical record. A new or revised LaPOST document can be completed if substantially different and appropriately recorded. If a new LaPOST document is created, the earlier version is voided and that is recorded (see side 2 of document). The LaPOST document is a living document and should reflect the patient’s treatment preferences and goals of care.