MOST Information for Health Care Providers

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 Practitioner (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 long-term 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.

Why MOST?

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.

Watch this video below to see an example of how a family might work with a loved one's care team to start discussing how to complete a MOST.

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Information for the Most Responsible Practitioner (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 or nurse practitioner 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)

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