The West Virginia Physician Orders for Scope of Treatment (POST) program and form is part of the National POLST. Information on this page is provided by the National POLST with edits for emphasis on West Virginia.
What is "POST" or "POLST"?
Referred to as "POLST" at the national level, POLST is a national movement, implemented at the state level, that supports patient autonomy regarding treatment preferences during a medical emergency. The "P" used to mean "Physician" but it means so much more than that:
"P" for Process. POLST is not a form: it is a process. The POLST form is the most visible part, but the process behind its completion is the most important part. The conversation between the patient and their health care professional should include the patient’s goals of care considering current diagnosis, prognosis, and treatment options (including risks and benefits of each). The result of the conversation may be the completion of a POLST form—or it may be a first step in the care planning process.
POLST stands for Physician Orders for Life-Sustaining Treatment. In West Virginia, this is referred to as "POST," and acronym for Physician Orders for Scope of Treatment. The name difference for West Virginia was utilized to be encompassing of all medical orders, including that of Do Not Resuscitate which is not considered life-sustaining. The name change does not impact quality or legitimacy of the WV POST program or form in relation to the National POLST.
"P" is for Patient. The POLST decision-making process and resulting medical orders are intended for patients who are considered to be at risk for a life-threatening clinical event because they have a serious life-limiting medical condition, which may include advanced frailty. Read more about for whom POLST is appropriate.
The WV POST form is not appropriate for everyone. Refer to the appropriate patient hyperlinked above from the National POLST for guidelines. For information related to POST forms with individuals with disabilities, please contact the WV Center for End-of-Life Care. Comprehensive guidelines for this specific population will be released soon.
"P" is for Patient Autonomy. Patients have a right to participate in medical decision-making regarding their treatment plan. Participation in having a POLST form is always voluntary. Read more about the Appropriate Use of POLST.
POST forms, just like all medical orders and advance directives, is always voluntary. POST forms cannot be utilized as a requirement for admission into long-term care facilities.
"P" is for Portable. The POLST form is an immediately available, standardized, recognizable, portable, out-of-hospital medical order set that assists emergency personnel in providing treatments aligned with patient preferences during an emergency.
The WV e-Directive Registry helps ensure the availability of patients' forms, including POST forms, for health care providers 24/7 through the West Virginia Health Information Network. By submitting your patients' forms to the e-Directive Registry, WV EMS can search for a patient's medical orders on the way to an emergency call. This can result in necessary time-saving with understanding a patient's wishes related to CPR or DNR status.
"P" is for Professional (as in Inter-Professional). The name of the form varies among states. The POLST process can include many professionals. National POLST recommends physicians, advanced practice registered nurses, and physician assistants be permitted to participate in the POLST process and sign POLST forms (read more and see which can sign in each state). Other health care professionals, like social workers and chaplains, may have roles in the process too!
In West Virginia, only licensed health care professionals with one of the following credentials are authorized to sign POST forms:
"P" is for Palliative. Palliative care focuses on helping patients improve their quality of life, helping alleviate symptoms, and understand their choices for medical treatment. The POLST process can be part of palliative care.
Many palliative care resources in WV exist. For a resource list, please contact the WV Center for End-of-Life Care. Information can also be found on the National Hospice and Palliative Care Organization website.
"P" is for Planning (as in Advance Care Planning). A POLST form is an advance care plan and can support patients towards the end of life. Find out how POLST differs from other advance care plans, like advance directives, here.
Advance care planning documents are available for free through the WV Center for End-of-Life Care. Visit the "Forms and Resources" page to download the advance directives listed below and many other resources.
Medical Power of Attorney (MPOA)
Living Will (LW)
Mental Health Advance Directive (MHAD)
"P" is for Program. National POLST is the national entity that provides guidance and support to state POLST programs. From its start, the POLST movement has been a voluntary, collaborative group process. Our policies, guidance and program recognition standards have all been created through group consensus and each state POLST program chooses if they want to participate. We are grateful the vast majority of states believe that, collectively, we can have a greater impact in eliciting, documenting and honoring patient treatment wishes by building National POLST together. Thank you to the states participating in the national governance of POLST!
The West Virginia Center for End-of-Life Care was one of the first states recognized for meeting all the recommended POLST program elements by the National POLST. The Center continues to be an active member of the National POLST and the Center's Program Manager, Danielle Funk, is actively involved in many POLST committees.
"P" is for Paradigm. The purpose of this organization has been to shift the focus from health care professionals automatically providing the standard of care to encouraging them to elicit, document and honor what treatments the patient wants to receive. Paradigm means model, as in a model for health care practice.