A Medical Order for Scope of Treatment (MOST) is a medical order that identifies one of six designations for scope of treatment. These designations provide direction on adult resuscitation status, critical care and medical interventions.
Completed by the Most Responsible Physician (MRP), A MOST is based on Advance Care Planning and conversations with a capable adult about their goals of care - or if the adult is incapable, their Substitute Decision Maker (SDM).
MOST has replaced “No CPR orders” in acute and residential care. MOST is valid in all care settings including community and honoured by the BC Ambulance Service. The BC No Cardiopulmonary Resuscitation form also remains valid.
Ideally, a MOST is completed following Advance Care Planning and goals of care conversations with patients and their families.
MOST clarifies the intent of treatment and helps health care providers deliver care that aligns with the adult's values, goals and health conditions, minimizing unnecessary or unwanted treatment.
While MOST does not replace the consent process required at the time of care, it can help to focus discussion on what is appropriate and desired care for the individual adult. MOST orders can help to ensure that substitute decision makers and health care providers are following the legal duty to provide care that is desired and refrain from initiating undesired care.
Information for the Most Responsible Physician (MRP)
- Review all ACP documents, information, and conversations.
- In collaboration with the adult or Substitute Decision Maker (SDM if the adult is incapable), engage in ACP & Goals of Care Conversations.
- Review the existing MOST (if applicable) or complete a new MOST, if appropriate. Provide a copy of the MOST to the adult or SDM on discharge
- Advise the adult/SDM to: Place a copy of documents in an accessible area at home (paramedics will check the outside of the fridge) and share the MOST with primary care physician and providers.
Information for all health care providers
Collaborating to determine a MOST
- Determine if ACP or MOST documents exist on the adult's health record.
- Ask the adult/Substitute Decision Maker (SDM) if they have an ACP documents or a MOST.
- Discuss ACP and the adult's goals of care with adult or SDM (if the adult is incapable).
- With each new care setting, a MOST specifies a medical order to follow until it is reviewed or updated by the MRP.
- If there is no MOST and you feel the adult would benefit from having one, communicate this to the MRP.
- Document the results of conversations and any new actions (e.g., new MOST, conversations, documents obtained or verified). Advance Care Planning Notes and Conversations form (pdf)
Providing care according to MOST
- Always ask the adult about their preferences for care when they are able to speak for themselves. If the adult is incapable, ask their SDM. Refer to MOST for resuscitation status and scope of treatment.
- Obtain consent for medical treatment according to the Health Care Consent and Care Facility Act.
- If the adult is:
Capable: Obtain consent from the adult.
Incapable: Obtain consent from the SDM, if available.
- In an emergency situation, if the adult is incapable and SDM is not able to provide direction, the last valid MOST is followed.