Vital Signs

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ELECTRONIC HEALTH REC ORD Advance Care Planning Goes Electronic at UCLA In recognition of the importance of advance care planning — discussions between patients and their physicians regarding prognosis and future decisions that might arise in their care — UCLA Health has taken steps to ensure that patients’ wishes are captured in UCLA’s electronic health record and prominently displayed to inform their current and future providers across the health system. related health problem, such as hypertension, diabetes, sleep apnea, severe joint pain, high cholesterol, nonalcoholic fatty liver disease or heart disease, along with an inability to achieve healthy and sustained weight loss through diet and exercise. The consensus among weight-loss surgeons is that women should wait 12-to-24 months following bariatric surgery before trying to become pregnant. “We worry about nutrient deficiency with the rapid weight loss, so we recommend using contraception for at least a year until we have confirmed that there is no vitamin deficiency,” Dr. Chen says. Because of this, he notes, for obese women who are in their mid-to-late 30s or older and experiencing difficulty with conception, it may be better not to delay seeking in vitro fertilization. “But if you are in your 20s or early 30s,” he says, “it makes sense to have the surgery first, lose weight, then see if you can become pregnant naturally.” To view a video about obesity and women’s health, go to: Among the advance care planning tools is Physician Orders for Life-Sustaining Treatment (POLST), a form that allows seriously ill patients to specify the medical treatment they want to receive. By signing the POLST form with one’s physician, UCLA patients can indicate their desire to avoid or receive measures such as resuscitation, ventilators and feeding tubes, as well as their preference for life-sustaining versus comfort-oriented treatments, explains Neil Wenger, MD, director of the UCLA Health Ethics Center and chair of the Ronald Reagan UCLA Medical Center Ethics Committee. POLST is designed to foster discussions among seriously ill or frail patients, their loved ones and their physicians about care goals, and to ensure that patients’ wishes are honored. The discussions are typically initiated by physicians, but Dr. Wenger encourages patients who have strong preferences regarding a certain type of care to bring up the issue. “Unlike an advance directive, which makes it known ahead of time what type of end-of-life care you would want when you are unable to make decisions for yourself, the POLST is for patients to indicate the type of care they want based on their current health status,” Dr. Wenger explains. “These sorts of decisions are common among residents of nursing homes and also among some people living in the community, but it’s important for those with advanced conditions to have the discussion.” For patients who, with their physicians, choose to complete a POLST, the forms are available throughout UCLA Health. The POLST is entered into the electronic health record under a special tab so that it is easily visible to healthcare providers and can be factored into care decisions. “Medicine today is complicated, and it’s very important that it is guided by explicit conversations with patients about goals and values,” Dr. Wenger says. “POLST is just one of the tools that we use to make sure patients’ goals and preferences are integrated into the care they receive.” If patients have in the past filled out a advance directive of POLST, it is recommended that they ensure it is made accessible to all treating physicians. womenandobesity Vital Signs Fall 2015 Vol. 68 11