MOST in Colorado

The New Colorado MOST: Effective April 16, 2015

Based on your feedback in concert with dynamics in the national POLST movement, CADC has updated the Colorado MOST form. It is available for download here as of April 6, 2015–National Healthcare Decisions Day. Download the form and the instruction booklet below, and read the FAQs.

Updated MOST Form

MOST Instruction booklet rev 2015 2017

MOST FAQs

Summary of Changes to MOST Form 2015

Then watch this informational video by CADC Co-Chair, David Koets, MD, outlining the changes to the form.

 

The Medical Orders for Scope of Treatment (MOST) is a tool and process for documenting treatment preferences that is
Standardized • Efficient • Portable • Flexible • Updatable • Effective

The Medical Orders for Scope of Treatment form is a 1-page, 2-sided document that consolidates and summarizes patient preferences for key life-sustaining treatments including: CPR, general scope of treatment, antibiotics, artificial nutrition & hydration. The program was established by legislation (C.R.S. 18.7) in Colorado in 2010.

ColumbineOn the form, individuals may refuse treatment, request full treatment, or specify limitations.

The standardized form can be easily and quickly understood by patients, healthcare providers, and emergency personnel.

It is primarily intended to be used by the chronically or seriously ill person in frequent contact with healthcare providers or already residing in a nursing facility.

The Medical Orders for Scope of Treatment is completed by the patient or authorized healthcare agent in conversation with a healthcare professional, then signed by the patient/agent and a physician, advanced practice nurse, or physician’s assistant.

The physician/APN/PA signature translates patient preferences into medical orders.

The Medical Orders for Scope of Treatment “travels” with the patient and must be honored in any setting: hospital, clinic, day surgery, long-term care facility, ALR, hospice, or at home. The original is brightly colored for easy identification, but photocopies, faxes, and electronic scans are also valid.

The portability of the form allows seamless documentation of treatment preferences and closes gaps as patients transfer from setting to setting or experience delays in access to providers.

The latitude of authorized signers (physician/APN/PA) allows prompt documentation of preferences in rural regions or areas where physicians and healthcare services are scant.

Treatment preferences may be previously or more extensively documented in the patient’s advance directives. Completion of Medical Orders for Scope of Treatment does not replace or invalidate prior directives. In cases of conflict, please refer to the MOST Instruction Booklet (download here) for guidelines.

A section on the back prompts patients and providers to regularly review, confirm, or update choices based on changing conditions.

The Medical Orders for Scope of Treatment is a variant of the Physician’s Orders for Life-Sustaining Treatment (“POLST”), pioneered in Oregon in the late 1990s. Similar programs are now officially sanctioned in many states and are in development in all but a handful of states (see the national POLST website for details and program contacts).

Extensive research indicates that the Medical Orders for Scope of Treatment program greatly improves utilization of advance care planning and adherence to expressed wishes. (Visit the national POLST website for references and research findings.)

The Medical Orders for Scope of Treatment program in Colorado is spearheaded by the Colorado Advance Directives Consortium, a multidisciplinary volunteer group including representatives from health care (hospital, hospice, long-term care), professional associations and statewide organizations (Colorado Medical Society, Colorado Bar Association, Colorado Center for Hospice & Palliative Care, Colorado Health Care Association, Colorado Hospital Association) government and social services (CDPHE, EMS, ombudsman, DRCOG, HCPF, legislators), healthcare ethics, elder law attorneys, and others.

The CADC also offers education on the MOST through a network of volunteer trainers. To schedule a presentation or learn about upcoming trainings, please click here to contact us.Doc-Advising-Pt

IMPORTANT: Legislation to implement the MOST program in Colorado was passed in the 2010 session. The CADC is currently working with other stakeholder organizations to offer education on the program to emergency medical responders, long-term care facilities, hospitals, and primary care providers, hospice agencies. Widespread education and “buy-in” is needed to fully implement the program.

Until our education initiative is completed, the MOST form may not be immediately recognized by all healthcare providers in the state. You can help us educate your colleagues, providers, and provider partners by directing them to this site and to the educational programs. For questions or to participate in the statewide roll-out, please click here to contact Colorado Advance Directives Consortium.