Healthcare Professionals
NM MOST and Healthcare Professionals
NM MOST is a process and document designed to help healthcare professionals honor the healthcare wishes of their patients who are seriously ill, are very frail, or have a limited life expectancy.
The NM MOST program is intended to improve the quality of care people receive at the end of life by turning patient goals and preferences for care into medical orders that are actionable in any setting. The NM MOST is printed on bright green paper (65# Wausau Astrobright Terra Green) so that it is easily recognizable in an emergency; however, photocopies, faxes, and electronic scans are also valid. The original NM MOST document should always stay with the patient.
The NM MOST process starts with a conversation and ends with a completed and signed NM MOST form. Conversations with patients should include:
Patient’s Diagnosis - What disease(s) or medical conditions does the patient have? What does the patient understand about their condition?
Patient’s Prognosis - What is the likely course of the disease or condition? What might the patient expect over time? What are the patient’s expectations regarding their illness?
Treatment Options - What treatments are available to the patient? What are the potential benefits and potential burdens of the different treatment options?
Goals of Care - What is important to the patient? What is their definition of too much treatment and too little treatment? What are their thoughts about quality of life?
Tips for Completing
the NM MOST
The NM MOST must be based on the patient’s current health status and should be completed during the course of a conversation between the patient and a healthcare professional.
Ensure patient demographics are completed to allow for proper identification.
Ensure choices are clinically aligned.
Section A: Counsel patients on all options for resuscitation, including the ability to revoke a DNR at any time.
Section B: This section allows a patient to define the level of care that is consistent with their preferences. There is space provided for additional orders and clarifications of those orders.
Section C: If a patient elects a time-limited trial for hydration and/or nutrition, be sure to quantify and qualify the goal.
The NM MOST must be signed and dated by a physician (MD, DO), advanced practice nurse (APN), or physician assistant (PA).
The NM MOST must also be signed and dated by the patient or by their legally recognized healthcare decision maker (also known as a POA, durable medical power of attorney, or agent).
The original NM MOST form must stay with the patient. It is recommended that a copy of the form be placed in the patient’s medical record. Copies can be made and are valid.
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Patients & Families
NM MOST Form