MOST information for health care providers

A Medical Order for Scope of Treatment (MOST) is a medical order that identifies one of six treatment designations. These guide decisions about resuscitation, critical care and other medical interventions for adults.

The Most Responsible Practitioner (MRP) completes the MOST after discussing goals of care with a capable adult or, if the adult is incapable, their Substitute Decision Maker (SDM).
The order is informed by Advance Care Planning (ACP).
MOST has replaced “No CPR” orders in acute and long-term care.
It is valid in all care settings, including the community, and is recognized by BC Emergency Health Services.
The BC No Cardiopulmonary Resuscitation form remains valid.

Why MOST?

MOST helps health care providers deliver care that aligns with an adult’s values, goals and health needs. It can help avoid unwanted or unnecessary treatment and support conversations about appropriate care.

MOST does not replace the need to obtain consent at the time of care. It helps guide decisions about treatment an adult wants or does not want.

Information for the Most Responsible Practitioner (MRP)

Review existing ACP documents, relevant information and previous conversations.
Discuss ACP and goals of care with the adult or their SDM, if the adult is incapable.
Review the existing MOST or complete a new one, if appropriate.
Provide the adult or SDM with a copy of the MOST on discharge.
Advise the adult or SDM to keep care documents somewhere accessible at home. Paramedics may check the outside of the fridge.
Encourage them to share the MOST with their primary care provider and other care providers.

Information for all health care providers

Discussing and confirming a MOST

Check the adult’s health record for existing ACP documents or a MOST.
Ask the adult or their SDM if they have ACP documents or a MOST.
Discuss the adult’s goals of care with them or their SDM, if the adult is incapable.
Follow the current MOST in each care setting until the MRP reviews or updates it.
If the adult may benefit from a MOST and does not have one, contact the MRP.
Document discussions, decisions and actions taken, including any new or verified documents.

Providing care according to a MOST

Ask the adult about their care preferences whenever they can communicate them.
If the adult is incapable, consult their SDM, if available, and refer to the MOST for resuscitation status and scope of treatment.
Obtain consent for treatment according to the Health Care Consent and Care Facility Act.

Consent and emergency situations

Adult is capable: Obtain consent from the adult.
Adult is incapable: Obtain consent from the SDM, if available.
Emergency and SDM unavailable: If the adult is incapable and the SDM cannot provide direction, follow the last valid MOST.