Comfort Measures ONLY

  1. 1
    What exactly constitutes this?And since you need a physician's order for oxygen, should this be considered a "within nurses' discretion for comfort measures. And why not just the physician or hospital write what the comfort measures should consist of or not.
    nursedeanna likes this.
  2. 20 Comments so far...

  3. 0
    They do, at my hospital. There is a comfort measures protocol sheet that the doctor fills out, with check boxes and blank spaces next to different interventions that the doctor selects.
  4. 1
    At our hospital, treatment under CMO is usually under the direction of the Palliative Care team. I have made suggestions at times, most have been heeded. For example, I suggested an order for a foley for a woman for whom rotating and moving her to change frequent wet diapers (she was on a Lasix drip) was causing her pain.
    manncer likes this.
  5. 23
    Quote from Katie5
    What exactly constitutes this?And since you need a physician's order for oxygen, should this be considered a "within nurses' discretion for comfort measures. And why not just the physician or hospital write what the comfort measures should consist of or not.
    Comfort measures are generally outlined in standing order sets within the hospital. In the absence of standing orders signed by the MD, specific orders should be written.

    Comfort orders generally include things like, no routine lab draws, discontinuation of routine VS checks especially during the night, diet as tolerated, O2 for comfort, and liberalized medication plans for pain, anxiety, nausea, etc. Foley catheters are often ordered for patient dignity and comfort and are provided only if the patient or the family agree. Initiation of the specific elements of the comfort orders is based upon the assessment of the RN and does not require the notification of the MD when they are used. Every attempt is made to remove all noxious interactions which are not absolutely required for the well being of the patient. The focus of the care becomes comfort rather than diagnostic or curative.

    Comfort care orders may include use of some medications in a fashion which some nurses may not be familiar or comfortable. For instance, use of morphine for dyspnea may be new to some med surg nurses or use of haloperidol for nausea may be unfamiliar.

    Frequently medications which are not critical to the immediate comfort of the patient are discontinued.

    In the hospital setting family visitation hours are often liberalized to allow family nearly unlimited access to their loved one in the final hours/days.
    Hoozdo, rngolfer53, Up2nogood RN, and 20 others like this.
  6. 0
    in some states the term "palliative care" has to be used in the order, or there may be a risk of MD & nurse not providing the appropriate standard of care. I would bring this to the attention of the compliance/risk mgmt person or CNO because an order for "comfort measures" is not specific enough. The MD could order "Palliative Care protocol", if you have one, and that would give you a list of the standards for that order. Otherwise - you are out on a limb in my humble opinion. After all, isn't ALL our measures for comfort?
  7. 0
    deleted duplicate post
    Last edit by Bill E. Rubin on Feb 5, '10
  8. 8
    Quote from cityhawk
    . For example, I suggested an order for a foley for a woman for whom rotating and moving her to change frequent wet diapers (she was on a Lasix drip) was causing her pain.
    That's great that you advocated for your pt, cityhawk!

    Please make sure you refer to "diapers" as briefs when working in the clincial setting (unless you are dealing with young children). It is a degrading and negative term when referring to the elderly, especially those toward the end of their lives. It does nothing to help preserve their dignity.

    this is a big pet peeve of mine; and I'm sorry if my post offended you in any way.

    Best,
    Diane, RN
    mc3, Batman25, thehipcrip, and 5 others like this.
  9. 2
    Quote from tewdles
    Comfort measures are generally outlined in standing order sets within the hospital. In the absence of standing orders signed by the MD, specific orders should be written.

    Comfort orders generally include things like, no routine lab draws, discontinuation of routine VS checks especially during the night, diet as tolerated, O2 for comfort, and liberalized medication plans for pain, anxiety, nausea, etc. Foley catheters are often ordered for patient dignity and comfort and are provided only if the patient or the family agree. Initiation of the specific elements of the comfort orders is based upon the assessment of the RN and does not require the notification of the MD when they are used. Every attempt is made to remove all noxious interactions which are not absolutely required for the well being of the patient. The focus of the care becomes comfort rather than diagnostic or curative.

    Comfort care orders may include use of some medications in a fashion which some nurses may not be familiar or comfortable. For instance, use of morphine for dyspnea may be new to some med surg nurses or use of haloperidol for nausea may be unfamiliar.

    Frequently medications which are not critical to the immediate comfort of the patient are discontinued.

    In the hospital setting family visitation hours are often liberalized to allow family nearly unlimited access to their loved one in the final hours/days.
    That is exactly how it unfolds where I work. It is such a relief to not have bother the doctor for every step we want to take. We just assess and then do whatever we need to do. Our palliative patients usually are given an order for morphine 1-10mg q15min long before it is needed so we are ready. We do frequently use morphine for dypnea.
    tewdles and leslie :-D like this.
  10. 2
    Quote from classicdame
    in some states the term "palliative care" has to be used in the order, or there may be a risk of MD & nurse not providing the appropriate standard of care. I would bring this to the attention of the compliance/risk mgmt person or CNO because an order for "comfort measures" is not specific enough. The MD could order "Palliative Care protocol", if you have one, and that would give you a list of the standards for that order. Otherwise - you are out on a limb in my humble opinion. After all, isn't ALL our measures for comfort?
    I completely agree with the use of palliative care rather than comfort measures in all official documents. It is true that all order sets I have ever seen, or worked with, use the more precise terminology while the staff commonly refer to them as comfort orders or similar. This is an excellent distinction that may well save someone some grief...KUDOS!

    Oh how I wish all measures in health care were for comfort. Unfortunately, I believe there are far too many people who are receiving care which is motivated by interest in things other than comfort, particularly in the last decade of life. Too many choices are made out of fear...on the part of patients, families, and health care providers. Of course, it is easy for me to see this, because I work with people at the end of their lives...so all of my vision is retrospective.
    Hoozdo and Nurse_Diane like this.
  11. 8
    Just a funny side note. I agree with Diane in regards to referring diapers as briefs. I have done that and then the pt will look at me confused and ask, "you mean the diaper?". This has happened many times and I end up using whatever term the pt uses so as not to confuse my already confused pt's.


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