Quote from payang0722
what is the difference between comfort measures only, hospice, dnr...what is the exact difference? ( i know some, but i'll appreciate if someone can clearly explain it.) thanks a lot in advance.
in my state of massachusetts there are very specific rules and regs for comfort care.
all comfort cares are dnr (do not resuscitate) patients. this was developed because ems personell were required to intervene with all methods available to them including intubation because the law and their protocols did not recognize hospital dnr orders. comfort care patients wear a special bracelt not unlike a hospital band that designates them as cc. ems personell recognize this and will transport patients without intervention and treatment. comfort care is and must be a dnr and these patients are recieving no interventions, labs treatment..... except those approved by the family for the patients comfort only...ie: pain meds or morphine gtts sometimes iv fluids but that is usually to keep the morphine infusing and at time oxygen. all meds anitbiotics treatments are stopped....death is inevitable and imminent.
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aug 19, 2007, 11:13 am
originally posted by espikey
in reading this thread, i'm a bit confused- what is the difference between comfort care and hospice
not much really. the new term being tossed around these days is end of life care. here are some links to information about it:
a hospice patient, is a patient with a terminal diagnosis to set in motion of services for the family to assist with the dying process and counseling services made available. it's a way to get everyone on the same page so to speak of the grim prognosis, assist with end of life planning, obtaining information and services for the patient and education for everyone. the terminology was developed to obtain reinbursement for services for insurance companies and medicare. a hospice patient does not need to be, and isn't always, a dnr. this is a patient with a terminal/grim prognosis but if they want all heroic measures taken until the end it is their choice. so they are terminal and usually still recieving treatment, meds, interventions, chemo, maybe a dnr but not always a dnr.
do not resuscitate is a patient for whatever reason does not want heroic measuers taken. they usually have some terminal or grave prognosis but not always. a copd patient may want everything done except intubation because they don't want to live on a vent. dnr's may specify what they do not want ie: to be placed on life support... but wish interventions to still be performed like surgeries,meds,antibiotics, insulin and have medical care up to but not including cpr, drugs, intubation, ventilation. a dnr may specify what interventions are desired for each individual patient. a patient may want to be coded but no intubation. some patient don't want cpr (yes it's a waste of time usually) but want meds and defib. some want meds and no defib. a dnr has also been refered to as a living will. but... not all states recognize a written will. a dnr patient does not need to be on hospice or be a comfort care. a dnr is only recognized with in the medical facility that orders it and must be re-written and renewed for each facility and every 3 days when admitted. it is not recognized by ems personel. a living will "advanced directive" is not recognized by every state so you must check with you state you reside....even if you have a living will or advance directive the state doen't have to recognize it....it's purpose is only so they surving family is aware of your wishes.
below a summary
understanding do not resuscitate orders (dnr)
what are dnr orders?
dnr means "do not resuscitate." dnr orders are written instructions from a physician telling health care providers not to perform cardiopulmonary resuscitation (cpr). cpr uses mouth-to-mouth or machine breathing and chest compressions to restore the work of the heart and lungs when someone's heart or breathing has stopped. it is an emergency rescue technique that was developed to save the life of people who are generally in good health.
note: if you do not have a dnr orders, health care providers will begin cpr in an emergency.
frequently asked questions
cpr is a vigorous emergency procedure and it is not always successful. experience has shown that cpr does not restore breathing and heart function in patients who have widespread cancer, widespread infection or other terminal illness.
a patient may not want cpr attempted when:
there is no medical benefit expected. cpr wasn't meant for people who are terminally ill or have severe health problems. cpr is not likely to be successful for these people.
quality of life would suffer. sometimes cpr is only partly successful. though the patient survives, they may suffer damage to the brain or other organs or permanently may be dependent on a machine to breathe. this can be particularly true for the elderly and very frail.
death is expected soon. persons with terminal illness may not want aggressive interventions but prefer a natural peaceful death.
advanced cpr offers additional interventions which can include:
intubation - the insertion of a tube into the mouth or nose to help with breathing.
mechanical ventilation - the use of a machine to move air into the lungs.
medications - given through a vein, drugs can help with blood pressure regulation, heart rhythm, and blood flow.
cardioversion - the use of a controlled electrical shock to change heart rhythm.
glossary of terms
cardiac chest compression:
the force applied by pressing with both arms over the mid-chest to restore circulation of blood by the heart. because a great deal of force is needed, there can be injury to the surrounding area as a result.
cardiopulmonary resuscitation: the vigorous emergency procedure to restore heart and lung function in someone whose heart or lungs have stopped working. basic cpr involves chest compression and mouth-to-mouth breathing. advanced cpr includes the use of medications to regulate blood pressure and heart rhythm, controlled electrical shock to change heart rhythm, and intubation and mechanical support of breathing.
the physician's order to withhold resuscitation. no cpr.
dph comfort care/dnr:
the massachusetts department of public health document that verifies to emergency medical personnel that the person does not want resuscitation.
cardioversion or defibrillation:
the use of controlled electrical shock to treat certain kinds of heart rhythm problems.
a tube inserted through the mouth or nose to open the person's airway to assist with breathing. intubation prevents a patient from talking or eating by mouth.
the use of a machine that pumps air into the lungs of a person who is unable to breathe on his/her own.
medications for advance life support:
the use of very potent medications given through the veins that help to correct problems with blood pressure ("pressors"), heart rate and rhythm.
the use of basic or advanced life support treatments in an emergency situation begun when someone has stopped breathing or whose heart has stopped beating.
it's a complicated issue as you can see i hope this helps.......:redpinkhe