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Medical Orders for Scope of Treatment (MOST) in Colorado
A new tool for documenting treatment preferences that is
Standardized • Efficient • Portable • Flexible • Updatable • Effective
 
Standardized Colorado MOST form
 
 
NEW!
 
 
NEW!
 
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 This e-mail address is being protected from spambots. You need JavaScript enabled to view it .
  
MOST FAQs updated 2/2011: 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!

IMPORTANT: Legislation to implement the MOST program in Colorado was passed in the 2010 session and is now in effect. The Colorado Advance Directives Consortium and Life Quality Institute are 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  This e-mail address is being protected from spambots. You need JavaScript enabled to view it  at Life Quality Institute.
 
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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. In cases of directly conflicting instructions, the most recently executed document rules. 
 
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 early 1990s. Similar programs are now officially sanctioned in Oregon, Washington, West Virginia, New York, California, South Carolina, Tennessee, Idaho, Pennsylvania, and parts of Wisconsin, as well as Colorado. Programs are being developed in 21 states.
 
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 Trained Educators
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.