Palliative Care Program

Medical Orders for Life-Sustaining Treatment

Medical Orders for Life-Sustaining Treatment (MOLST) is a document designed to help health care providers honor the treatment wishes of their patients. This newly revised document (DOH-5003) revised on 6/10, sets forth the legal requirements for issuing medical orders with respect to withholding and/or withdrawing life sustaining treatment, including cardiopulmonary resuscitation.

  • This document summarizes a patient’s current treatment preferences with regard to:
    • Do-not-resuscitate (DNR)
    • Do-not-intubate (DNI)
    • Future hospitalization
    • Feeding tube
    • Other treatment preferences
  • Centralizes information on these issues
  • Facilitates record keeping
  • Ensures transfer of appropriate information between health care providers and between health care settings

The MOLST form does not replace advance directive documents. The MOLST characterizes a patient's current treatment preferences, whereas an advance directive helps guide medical decision-making if patients lose the ability to speak for themselves in the future.

All of the acute care hospitals in Rochester and many hospitals and nursing facilities in New York State are now using the MOLST, which has been formally recognized by the New York State Department of Health. In addition to its widespread use, the MOLST can now serve as a substitute for the non-hospital DNR form. This allows orders and limitations to be completed once. MOLST orders could be reviewed/updated as necessary to remain in effect when a person changes medical facilities or if his or her preferences change in the future.

To learn more, see the updated MOLST Frequently Asked Questions (FAQs) & Potential Checklists for Special Populations.

Pain Management Pocket Card

Most health care providers throughout the hospital and Rochester community have been trained in the World Health Organization (WHO) pain standards. We are committed to comprehensive pain assessment and treatment for patients experiencing moderate to severe pain. As part of that commitment, we have worked with experts in palliative care and pain management to create convenient and age-specific pocket cards—one for children and one for adults—with prescribing principles and guidance about medication dosage.

Pain Management Pocket Card – ADULT

Pain Management Pocket Card – PEDIATRIC

Use of Ketamine

Ketamine has a special role in the palliative treatment of intractable pain. Because Ketamine is an anesthetic, its use in a palliative setting should be restricted to pain or palliative care specialists.

Ketamine 2012 Dose Guidelines

SMH Policy Statement 8.11.3 on Administration of IV Anesthetic Agent Ketamine for Inpatient Treatment of Intractable Pain

View other pain management tools for professionals.

Methadone QTc Prolongation Monitoring Guide

Information about the potential association of Methadone and QTc interval prolongation, and monitoring quidelines is available here.

Percutaneous Endoscopic Gastrostomy (PEG)/Tube Feeding Guidelines

Updated PEG and Tube Feeding Practice Guidelines - The Monroe County Medical Society has recently released updated Community-wide Practice Guidelines for physicians, other clinicians, patients and families on the use of Percutaneous Endoscopic Gastrostomy (PEG) Tubes and Tube Feeding in general. In addition to providing an up-to-date review of the current clinical evidence on this subject, new information is included about related legal issues in light of the Family Health Care Decisions Act.

View updated guidelines http://cwcg.mcms.org/CWCGClinicalGuidelines.aspx

Protocol for Transferring Patients to Inpatient Hospice

Protocol and specific electronic instructions for discharging a patient from acute inpatient care to inpatient hospice care are now available!

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