Who honors MOLST instructions?
Health care professionals (nurses, emergency responders, etc.) honor valid medical orders, including MOLST, in any setting where clinical care may be provided (including in the patient's home).
What if the clinician signer is unknown and/or doesn’t have privileges in the institution – or if a patient in crisis (with a MOLST form) has arrived and there is no clinician around?
The MOLST medical orders should be honored by any licensed health professional authorized to follow medical orders, until a clinician can review the situation and orders. This procedure should be incorporated into institutional policy and procedures.
If a patient has a MOLST on file in their record from a past visit and arrives with no MOLST form in hand, should the form on-hand in the file be honored?
This should be determined by the institution’s policy and procedures. Check with legal counsel on your task force about policy writing.
What if the MOLST form says “Attempt Resuscitation” but also says “Do Not Intubate and Ventilate” and/or “Do Not Transfer to Hospital (unless needed for comfort)?
If a person elects “Attempt Resuscitation” in Section A of the MOLST form, that decision “trumps” other decisions indicated in Sections B and C, and the patient may be intubated and ventilated and transferred to the hospital.
Can a hospice patient select “Do Not Transfer to Hospital (unless needed for comfort)?
Yes. Every patient should receive full attention to comfort. Any patient has the option for transfer to the hospital if it is medically indicated and needed or desired to maintain the patient’s comfort.
Regarding the patient's privacy, what suggestions do you have for keeping the MOLST available at the bed side when the patient is inpatient?
The form may be kept in a bright pink envelope or folder at the bedside.
With multiple versions of the Massachusetts MOLST form in circulation, which versions are valid? And, are future changes to the content of the MOLST form expected?
Several versions of the Massachusetts MOLST form are currently in use. All of these authorized versions are available to review on the MOLST website at www.molst-ma.org and are considered valid. It is expected that the MOLST form may change over time, though not frequently.
Will the MA MOLST form be honored in other states?
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. Likewise, MOLST/POLST/POST forms from other states are not considered valid medical orders in Massachusetts, but they may be considered as evidence of a patient’s preferences. Patients who reside in (or spend time regularly in) multiple states are recommended to discuss MOLST orders with clinicians in both states.