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An Introduction to the Nevada SMOST
The Nevada Summary of Physician Orders for Scope of Treatment (SMOST) is a one page, two-sided document designed to help health care providers honor the end-of-life treatment desires of their patients. The document is a medical order form that follows patient wishes and treatment intentions and thereby enhances the appropriateness and quality of patient care. It is not intended to be completed by the patient or the patient's family, but by a health care provider during an interview with the patient. It may be used as a Declaration, a type of advance directive or living will. The SMOST may not be used as a Power of Attorney for Health Care, which in Nevada must follow statutory wording, but you may indicate on the SMOST if you have a Power of Attorney for Health Care and who you have designated as your Agent on that document.
The SMOST form is easily recognized because of its bright pink color and standardized format. The document uses language to convey physician orders about specific medical treatments that is easily understood by nursing home staff, home health/hospice personnel, covering physicians, emergency medical services and loved ones of the patient.
The Nevada SMOST is now available to Nevada health care facilities. To order forms, arrange training or for other information, contact the Nevada SMOST Coordinator.
History of POST Development
NCEHP’s efforts to promote the SMOST follow the very successful lead of Oregon. The Oregon version (called the POLST - Physician Order for Life Sustaining Treatment) was developed over a four-year period by a multi-disciplinary task force of the Center for Ethics in Health Care at Oregon Health & Science University, with representatives from numerous health care professions and governmental and institutional organizations.
As has occurred commonly in Nevada as well, concern was voiced about the problem of interpreting and respecting end-of-life desires as expressed in an advance directive when patients are transferred from nursing home to hospital. In response to this need, the multi-disciplinary task force was convened to address the problem of preventing unwanted transfer and intensive medical interventions to those patients who did not want such interventions. Although less common, the document also can ensure intensive interventions are provided for those patients with such preferences.
After 12 years of use in Oregon, the POLST is used in almost every community larger than 5,000 people and more recently, versions have been adopted in West Virginia, Wisconsin and New Mexico.
How Does POLST Help the Patient?
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Documents a patient's wishes for life-sustaining treatment in the form of a medical order
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Streamlines transfer of patient records between facilities
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Clarifies treatment intentions and minimizes confusion about patient preferences
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Provides an quick summary of the advance directive and complements the Power of Attorney for Health Care
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Assists physicians, nurses, emergency personnel and health care facilities in promoting patient autonomy
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Optimizes comfort care of patients
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Allows periodic review and changing of orders as indicated by patient values and medical circumstances
How Does POLST Help Health Care Providers?
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Ensures readily available information for health care providers about the patient's treatment preferences
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Provides a system for communicating the medical orders for the patient to other care facilities,
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Is a safe and effective instrument that prevents unwarranted treatments and ensures that medically indicated treatments desired by the patient are provided, and
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Provides a practical way to assemble patient information on a one-page form.
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Allows periodic review and changing of orders as indicated by patient values and medical circumstances.
The SMOST form is primarily intended for patients in health care facilities such as nursing homes, extended care facilities, and acute care hospitals. The SMOST)may be used by those outside of such facilities, but any Do Not Resuscitate (DNR) order in such cases will only be honored if the patient also has an Out-of-Hospital DNR identification card. For more information on an Out-of-Hospital DNR Identification card please visit: http://health.nv.gov