Date: Thu, Apr 9, 2020 at 11:59 AM

I hope this email finds you doing well through this challenging time. In our effort to ensure that you and your loved ones are fully prepared for any illness, it is critically important that you have on hand now, not in your lawyers office or buried in a file cabinet,  all appropriate advanced directives. I know this is a sobering process but let’s make sure you have everything you need available to you, if needed. Everyone should have a copy of the following documents in an envelope that is labeled with: “Your Name, Emergency Information”. This envelope should be attached to the back of your door, the refrigerator or entry table easily visible for EMS. This packet should contain the following (for each member of the household):

1) Emergency contact information (see attached form)

2) List of your medications and all over the counter medication taken regularly (see attached form)

3) A copy of your Health Care Proxy

4) A MOLST form: Medical Orders for Life Sustaining Treatment  These directives inform medical providers of your health care wishes and require that they abide by them. If you have not had these conversations with your healthcare provider, schedule a call now with them to review and understand the MOLST form and the options outlined. If you need assistance having these difficult conversations, I strongly recommend 2 online expert organizations that will guide you: Honoring Choices, MA  and CAKE . Both these websites offer their resources free of charge.I am here to assist you with obtaining and/or completing any of the above forms that you do not have. Below, is an important update from Honoring Choices Massachusetts regarding the change made April 3 in the requirement to have  a physician sign the MOLST form in person during the state of emergency. Please be in touch with any questions. I am here to support you.

State allows Verbal Consent on MOLST
See New EMS Protocols for witnessed verbal consent

We are excited to announce that for the duration of the COVID-19 State of Emergency, the state has suspended the standard requirement of a written signature on a MOLST form and allows for verbal consent, to be reliably honored by all EMS personnel and licensed practitioners in hospitals, long-term care facilities and across all health care settings.

This offers an important remedy for clinicians where face-to-face MOLST conversations are not possible. Clinicians can now initiate proactive planning conversations via telephone or virtual means with high risk patients, their Health Care Agents and Guardians, to discuss goals of care and complete or revise a MOLST form with witnessed verbal consent.

The Emergency Update to the EMS Protocol 7.3  cites the following requirements for documenting verbal consent:

Where it’s not possible impossible to follow usual MOLST standards requiring written signatures, clinicians are to document on the MOLST form:

  • a) the patients, patient’s health care agent’s or guardian’s verbal consent;

  •  b) who witnessed this verbal consent (in accordance with the standards of the health care facility in which the patient is located); and in addition,

  • c) document in the patient’s medical record the details of how verbal consent was obtained.

Upon reviewing such a MOLST form for a patient they encounter, EMS personnel are to accept a form that contains a) and b) in accordance with this procedure. As long as the witness portion is documented, EMS can accept it as meeting the standards of the health care facility.

Please read the Full Emergency Update to Protocols 7.3 here
 
All health care facilities can rely on their standard policies to suggest procedures for their staff in alignment with the new protocols. 

Special thanks to the collaborative efforts of Lachlan Forrow, MD and our committed MA MOLST Advisory Subcommittee and MA Guardianship-MOLST Advisory Committee in sending a letter to the state to request a change in protocols. 

We are so thankful to Governor Baker and the incredible state leadership for their thoughtful policies to keep us all healthy and safe. We appreciate their prompt attention to this critical issue. It will greatly help our clinicians as they initiate conversations with high risk patients, their Health Care Agents and Guardians, to deliver the best possible care that honors an individual’s values and choices.

The protocols are posted at COVID-19 Guidance & Directives

  • In the Table of Contents, click on Emergency Responders & Law Enforcement

  • Scroll to Emergency Statewide Treatment Protocols:

MOLST Verbal Consent Protocols

Talk with you all soon. Take good care.

Best Regards,

Joan

Joan Harris, LSW, MBA, CMC
Aging Life Care Advanced Professional
P: (781) 591-3231
Founder of Symphony Care Management
Orchestrating Your Vision Together
www.symphonycaremanagement.com
Metrowest & Greater Boston
Executive Board, Aging Life Care Association™ New England, 2019, 2020President of Aging Life Care Association™ New England 2018