What is MOLST?
MOLST (Medical Orders for Life-Sustaining Treatment) is a discussion and medical orders that give patients more control over their end-of-life care. The document specifies the types of treatments that a patient wishes to receive toward the end of life. Completing a MOLST document requires communication between healthcare providers and patients, which enables patients to make more informed decisions about their medical treatment. The MOLST order documents patient’s decisions in a clear manner and can be quickly understood by all providers, including first responders and emergency medical services (EMS) personnel. As a result, the patient’s wishes can be honored across all settings of care.
Where should an EMS provider look for a MOLST form?
MOLST uses a digital-first approach, but eligible providers are strongly encouraged to send a patient home with a paper copy reflecting their choices. In a private home, check for the paper form on the refrigerator, on the nightstand or with the patient’s medical records. In a long-term care facility, a paper copy of MOLST is kept in the patient’s medical file or on the back of their bedroom door.
May the patient change their mind about their wishes?
Yes, the MOLST is voluntary. An individual has the right to revoke any MOLST order. The MOLST is there for times when an individual is unable to communicate their wishes.
Who else has the authority to change the MOLST order?
In the moment, if a patient wishes to modify their MOLST they may do so at any time.
What supportive measures may EMS provide that are not considered resuscitation?
- Supplemental oxygen without positive pressure ventilation
- Head tilt and chin lift to allow ease of breathing
- Body repositioning
- Warmth or cooling
- Care for injuries
- Oral hydration or feeding, if patient desires
What protocols exist for EMS providers in my state regarding MOLST
Please refer to the current Connecticut Statewide EMS Protocols linked below.
Link to Statewide EMS Protocols
Is the MOLST simply a DNR order?
No, MOLST is a document that empowers a patient or, when appropriate, their legally authorized representative (LAR) to make decisions along the whole continuum of care, from very aggressive life sustaining care to comfort care only, including choices about full resuscitation or do not attempt resuscitation.
Why isn’t the MOLST form considered an advance directive?
The MOLST form is not an advance directive because it is a medical document that contains actionable medical orders that are effective immediately based on a patient's current medical condition. Advance directives, including health care representatives and living wills, are legal documents that are effective only after the patient has lost capacity. In other words, a health care representative can make decisions for a person only after he or she has been determined to lack capacity; a living will is relevant only after the patient can no longer be consulted. A MOLST form, on the other hand, is a medical document signed by both the eligible provider and the patient, and is effective as soon as it is signed, regardless of a patient’s capacity to make decisions.
Should the DNR Bracelet still be honored by EMS?
Yes, the DNR Bracelet is still a valid method to communicate a patient’s intent about attempts to resuscitate. There are many of these bracelets in use, and EMS personnel should continue to honor this directive. DNR is just one component of a patient’s wishes. Learn more about Connecticut’s DNR Program here.
Does the MOLST form travel with the patient between settings of care?
Yes, the MOLST form is designed to be a standard form that may be accepted by all providers across the state. As a legal medical order, it can be honored by providers and facilities such as but not limited to EMS, hospitals, long-term care facilities, home care and hospice providers.
Outside of Connecticut, the MOLST instructions may be honored in some states but not in others. However, a MOLST form is always a good record of a person’s treatment decisions. Patients who reside in (or spend time regularly in) multiple states are recommended to discuss MOLST/POLST/POST orders with clinicians in both states.
When does the MOLST form expire?
The MOLST form does not expire. Reviewing the MOLST form with patients frequently is a best practice.
Where can I find more information about MOLST?
Please visit the DPH MOLST website for additional information. There is also a course specific to EMS providers available on CT TRAIN.