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Connecticut subcommittee outlines MOLST training, website and EMS guidance ahead of statewide rollout
Summary
An advisory subcommittee reviewed training slides, public education plans, EMS-specific guidance and unresolved policy language on digital vs. paper MOLST forms and revocation procedures; EMS and DPH staff were tasked with drafting concise materials for review at the next meetings.
The education subcommittee of Connecticut’s MOLST advisory group met March 10 to review slide decks and training plans for the Medical Orders for Life-Sustaining Treatment (MOLST) program, and to agree next steps for provider, EMS and public-facing materials.
The group focused on three near-term deliverables: finalize a general provider slide deck, draft a separate EMS slide deck and clarify language in the program’s policies and procedures about digital forms, amendments and revocations. Barbara Cass, a member of the subcommittee, said the policies currently state “the MOLST form is valid digitally or on paper,” and asked staff to confirm how the rules should be taught to providers.
Why it matters: MOLST orders are medical orders that instruct clinicians and emergency responders about a patient’s care preferences. The subcommittee said consistent, concise training is needed so hospitals, EMS and community providers recognize valid forms and understand how to act on them.
Key decisions and next steps
- Website and public education: The subcommittee agreed to defer a final decision about public-facing materials to the full advisory committee in April. Rebecca (last name not specified), who does community outreach, said she purchased the domain ConnecticutMOLST.org for nonprofit outreach and recommended layered public resources (brief videos, translated materials and community presentations) for different audiences. Department of Public Health (DPH) staff, including Melia, said the finalized materials will carry DPH branding once approved.
- Provider materials: Members reviewed a general slide deck that will serve as the master training pack. Cass asked staff to clarify one policy citation (noted in the packet as "page 2; Section 19 a 5 80 h/2") where the text currently reads that an eligible provider who signs a MOLST must provide documentation of MOLST training; staff (Dante and others) will confirm the correct requirement and revise slides accordingly. The group agreed to instruct providers to offer and, when requested, provide patients a printed copy of their MOLST: if printed from the digital portal, a paper copy should be given to the patient and a copy retained in the medical record.
- EMS guidance and training: Rich (last name not specified), representing EMS interests, agreed to lead development of an EMS-specific slide deck with John and Joel. He emphasized succinct operational guidance for first responders, including the legal authority of MOLST orders, how MOLST differs from DNR orders and practical ways to locate a current form in a home. The subcommittee discussed whether a paper MOLST should be kept in a standard, visible location (participants repeatedly suggested the refrigerator) so responders can find it quickly.
- Pediatric content: The group agreed to include a pediatric slide in the general provider deck. Dr. Carrie Moss, a pediatric oncologist at CCMC, will draft or review pediatric content; the group noted several pending bills on pediatric palliative care that may be relevant to future work.
Unresolved policy points
Members identified two sections in the policies and procedures that need clearer language for training: (1) the mechanics and provider responsibilities for revoking a paper or digital MOLST, and (2) the process for amending an existing digital MOLST when a patient’s care team changes. Cass noted one passage that says if a patient has a paper copy and revokes it “the paper shall be ripped and discarded,” and the participants asked staff to draft FAQ language explaining revocation and amendment practices across paper and digital systems. Scott (last name not specified) had previously discussed a digital workflow in which the newest form would appear on top and older records would remain available for historical reference.
DNR bracelets and recognition in the field
Members discussed how MOLST adoption interacts with DNR identifiers used by hospitals. Participants reported that Hartford HealthCare is issuing an orange verification bracelet when a discharged patient’s MOLST indicates do-not-attempt-resuscitation; the Connecticut College of Emergency Physicians also provides bracelet options. Several attendees warned this could create inconsistent recognition by EMS: Rich cautioned that in a time-sensitive cardiac arrest responders are likely to start resuscitation unless an immediately visible, trusted identifier is present.
Administrative items and timeline
- The subcommittee scheduled a follow-up to review updated slides and policy clarifications on or before March 24 (the next education subcommittee meeting). The next full MOLST advisory meeting is April 1, when public-facing website decisions and unresolved policy language will be discussed with the larger group.
- Assignments: Barbara Cass will circulate a revised slide deck; Rich, John and Joel will draft EMS slides; Melia will ensure final materials use Department of Public Health branding; Dante and legal staff will supply clarified policy language for the provider slides and the upcoming FAQ.
The subcommittee closed with an agreement to keep materials short and operational for EMS and provider audiences and to discuss public education strategy and website integration at the April 1 advisory meeting.
