MOLST is Done: Now What?

After MOLST is completed, a palliative care plan is needed to guarantee the patient’s MOLST orders are honored, pain and symptoms are managed and the caregivers are engaged, educated, empowered and supported.

The palliative care plan must include guidance on what to do and who to call in an emergency 24/7 when a patient does not wish to return to the hospital.

What to Do with a Completed MOLST

The MOLST form is a common community form that must be followed by physicians and all medical professionals.  MOLST is designed to travel with the individual between care settings.

Facility

The MOLST form represents medical orders that the patient wishes to receive and avoid now based on current health status and prognosis.  When a person is admitted to a facility, MOLST is honored and then reviewed after the patient has been evaluated, as the patient’s goals for care may have changed based on new health status and prognosis. As a result, the MOLST orders may change and the MOLST should be updated.  Patient preferences to withhold specific life-sustaining treatment are added to institutional medical orders, as per the facility’s policies & procedures.  The MOLST should be maintained in an easily accessible portion of the medical record and distinct from advance directives, like the health care proxy.  MOLST should be reviewed and updated based on the patient’s goals, health status & prognosis at the time of discharge.  This is easily accomplished in eMOLST.

Home

When the individual is at home, the MOLST form should be kept on the refrigerator, by the phone in the kitchen or by the individual’s bedside.  In case of emergency, EMS personnel are trained to look for the MOLST form in these locations.

Care Transitions

A photocopy of the MOLST form should be made when the individual is transferred from one healthcare setting to another (e.g., being admitted from a nursing home to a hospital).  The photocopy of the form should be kept in the medical chart at the original location at the time of care transition.  The original form should accompany the individual and be placed in the individual’s medical chart at the new care setting.  This is easily accomplished in eMOLST.