Thoughtful MOLST Discussions

MOLST orders are completed at the end of a thorough conversation or series of conversations between the patient (or the Health Care Agent or Surrogate if the patient is unable to make complex MOLST decisions) and their physician, nurse practitioner, or physician assistant. Conversations may include other medical team members, within scope of practice but the attending physician, nurse practitioner, or beginning June 17, 2020, physician assistant, is always accountable.

View the full 8-Step MOLST Protocol document

8-Step MOLST Protocol

1. Prepare for Discussion

2. Begin with what the patient and family knows

3. Provide any new information about the patient’s medical conditions and values from the medical team’s perspective

4. Try to reconcile differences in terms of prognosis, goals, hopes and expectations

5. Respond Empathetically

6. Use MOLST to guide choices and finalize patient and family wishes

7. Complete and sign MOLST

8. Review and revise periodically on page 3 & 4 of the MOLST form according to the following items:

After MOLST is Complete

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.

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