Medical Orders for Scope of Treatment (MOST)
A new tool for documenting treatment preferences that is
Standardized • Efficient • Portable • Flexible • Updatable • Effective
Click on the underlined text to download document or link to another site
for patient discussion only (Courtesy Longmont United Hospital)
Coming soon! Instructional video on DVD, "Getting the MOST Out of the Medical Orders for Scope of Treatment," including facilitator guide,
pre-/post-test for CEUs, and handouts.
NOTE: We recommend that you photocopy the Master MOST Form, 2-sided, onto "Wausau Astrobrights(R) Vulcan Green" 65-lb. paper. (This link will take you to one source for the Astrobrights paper, but it is available from many office supply stores. Astrobrights(R) Terra Green is also acceptable.) However, plain white photocopies, faxes, and scans are all valid. You may duplicate the Instruction booklet for your staff or provider partners; you may add your logo to the cover, if you like. You may NOT edit, alter, or add to the content. If you have suggestions for changes to the booklet content, please contact Jennifer Ballentine at email@example.com. NEW! MOST FAQs updated 12/2012: As the statewide roll-out of the MOST program gets underway, we are collecting and answering questions about the form, implementation of the program, and other issues. This is a working document--keep checking back for updates! New questions addressed:
- Is there a Spanish version of the MOST?
- What if we run out of slots to record reviews and there are no changes to the form?
- Is it possible to select "NO CPR" and "Full Treatment"? What about "YES CPR" and "Comfort Measures Only"?
REMEMBER: While no person or provider is required to complete a MOST, healthcare providers presented with a completed MOST MUST:
- Follow orders as written, or
- Obtain consent from patient or authorized decision maker to change orders, or
- Promptly and safely transfer patient to a healthcare provider who will follow the orders.
Ignoring, contradicting, or violating the orders on a properly completed MOST form is NOT permissible!
Contact Life Quality Institute by email or call 303-398-6326, to ask about the next scheduled MOST training for healthcare professionals.
IMPORTANT: Legislation to implement the MOST program in Colorado was passed in the 2010 session and is now in effect. The Consortium is currently working with other stakeholder organizations to offer education on the program to EMTs, long-term care facilities, hospitals, and hospice. 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 contact Colorado Advance Directives Consortium, via the co-chairs, Dr. David Koets (firstname.lastname@example.org) or Jennifer Ballentine (email@example.com).
Summary of the MOST Form and Program
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.
On the form, individuals may refuse treatment, request full treatment, or specify limitations.
The standardized form can be easily and quickly understood by patients, health care providers, and emergency personnel.
It is primarily intended to be used by the chronically or seriously ill person in frequent contact with health care providers, or already residing in a nursing facility.
The Medical Orders for Scope of Treatment is completed by the patient or authorized agent in conversation with a health care provider, 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 is 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 health care services are limited.
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. The Medical Orders for Scope of Treatment overrules prior instructions only when they directly conflict.
A section on the back prompts patients and providers to regularly review, confirm, or update choices based on changing conditions.
Receiving physicians may consult with patients or their authorized decision makers if the orders are deemed medically inappropriate to the patient's current condition.
Individual providers or facilities may "opt out" of compliance with a MOST order set which conflicts with personal values or institutional policy. In this case, patients must be promptly informed and transferred to the care of another provider or facility.
The Medical Orders for Scope of Treatment is a variant of the Physician’s Orders for Life-Sustaining Treatment, pioneered in Oregon in the late 1990s. Similar programs are now officially sanctioned in Oregon, Washington, West Virginia, New York, California, South Carolina, Tennessee, and parts of Wisconsin. Programs are being developed in 16 states including Colorado, and parts of 8 others.
Extensive research indicates that the Medical Orders for Scope of Treatment program greatly improves incidence of advance care planning and adherence to expressed wishes. (See the POLST Web site for references and research findings.)
Resources for Medical Orders for Scope of Treatment
Use these materials for your facility and community education on MOST. Also download and distribute the MOST form (on Wausau Astrobrights Vulcan Green 65-lb paper) and Instruction booklet -- links above.