Delaware medical orders use POLST name and record capacity findings

The measure uses “POLST” and “Delaware Portable Orders for Life-Sustaining Treatment” in place of “DMOST.” The names apply to the medical-order process and forms under Chapter 25A of Title 16, including references in other Delaware laws. Forms created under the former DMOST name remain valid if they meet the chapter’s requirements or the law that applied when they were created. The measure does not affect acts completed before its implementation date. The provisions apply to forms made before, on, or after the implementation date, and take effect when final regulations are published or six months after enactment, whichever comes first.

A health-care practitioner may find that a patient lacks capacity to make or sign a POLST form and must record that finding in the patient’s medical record. The rule covers adults making, changing, or canceling a POLST form and practitioners licensed and authorized to write medical orders under Title 24 who provide or oversee the patient’s care. The finding must follow a current examination, accepted professional standards, and the practitioner’s legal scope of practice. An authorized representative may not sign for the patient unless the medical record documents the lack of decision-making capacity. The rule applies when a capacity finding is made and when an authorized representative seeks to sign a POLST form after implementation begins.

A patient may state on the POLST form whether an authorized representative may later change or cancel it after the patient loses decision-making capacity. The rule covers patients who complete a POLST form and their authorized representatives, including agents, guardians, or other people allowed to make the patient’s health-care decisions. A representative must consult the patient’s health-care practitioner before changing or canceling the form. If the patient bars the representative from changing or canceling the form, the representative may not do so. Any change must follow applicable regulations. The choice is made when the POLST form is completed, and it controls later requests after the patient loses decision-making capacity.