Q: What makes a MOLST form valid? A: Section D (Patient Information) and Section E (Clinician Information) must be completed prior to arrival of the LMA for a MOLST form to be valid. Paramedics must assume that all signatures on the form are valid. A: The MOLST form does not need to be completed in each section to be valid. Each page can be valid independently of the other, and no page needs to be completely filled to be valid. Q: Where can I find a patient`s MOLST form? A: Find out locally if there is a MOLST form. In homes, check the refrigerator, the backs of doors and the sleeping area. Check the patient`s wallet (or ask someone else to check). The original MOLST shapes are bright pink, but a copy of any color is valid. Q: Who keeps the signed MOLST form? A: The person with advanced illness keeps the MOLST form in a place where it is easy to find (such as on the refrigerator, next to the bed or door), and it should be carried with them outside the home. Copies of MOLST forms are also valid and must be given to the person`s health care provider and primary care physician. Q: Who is best placed to use MOLST forms? A: People of any age (including children) with advanced illnesses or injuries who wish to express their preferences for life-sustaining medical treatments.
Is the Massachusetts Comfort Care/Do Not Resuscitate prescription verification protocol (CC/DNR form or Comfort Care form) still valid because the MOLST form is used? Q: Do paramedics have to follow MOLST forms? A: Yes. The Office of Emergency Medical Services (OEMS) of the Massachusetts Department of Public Health is responsible for emergency medical services and states that MOLST forms must be followed by emergency medical services personnel. Emergency Medical Services personnel should call the medical examination if they have any questions about MOLST instructions on site. Q: Is a copy of the front of a MOLST form valid? A: If Sections D and E are completely complete and legible, the instructions in a copy of the front of the MOLST form are valid. The MOLST form is a standardized medical order form that contains valid medical prescriptions. These prescriptions are the same as any other medical prescription followed by health professionals. Ministry of Education and Safety order compliance policies and procedures should be integrated into standard institutional practices for compliance with medical prescriptions (e.g., for obeying oral medical orders). Q: What happens if sections D and E are complete, but other sections of the form are empty? A: The form is still valid. If a section is empty, there are no restrictions on the processing specified in that section. In addition to the MOLST form itself, the Department has developed checklists for legal requirements and frequently asked questions. These checklists are NOT intended for patients with developmental disabilities who do not have medical decision-making skills, or for patients with mental illness in a psychiatric facility. The checklists are designed to help healthcare providers meet the complex legal requirements associated with life-sustaining treatment decisions for all other patients.
They are guides and the use of these checklists is not mandatory. However, providers who do not use the checklists must use another method to ensure that they strictly comply with all legal requirements for completing the form, including requirements for obtaining informed consent from the correct person on medical prescriptions, conducting the clinical judgments required to support prescriptions, refuse or discontinue life-sustaining treatment and, if necessary, obtain the consent of the ethics committee and witnesses. Q: Who follows MOLST`s instructions? A: Health care professionals (nurses, emergency responders, etc.) follow valid medical prescriptions, including MOLST, in any setting where clinical care can be provided (including the patient`s home). The Massachusetts CC/DNR (« Comfort Care ») form remains valid. The CC/DNR form can still be used to document that there is a valid DNR prescription for a patient, and it will be considered by paramedics in outpatient facilities. Since the MOLST (an actual medical prescription form) can be filled out to indicate « DNR » if it is the patient`s decision, the MOLST form can be used instead of the CC/DNR form. In some situations, patients may have both MOLST and CC/DNR forms. If both forms are present, the final instructions should be followed in case of cardiac or respiratory arrest.