comfort care?

  1. 0 I am anew RN grad that finally found a job at a SNF. My acute care training didn't provide me with LTC experience regarding "comfort care". I would appreciate any advice for my situation. I have a resident that has had all previous meds Dc'd (anti-anxiety, psychotropics, etc.) and is only prescribed liquid morphine PRN maximum dose 1 ml every 2 hours. She has now been comfort care for a month. While this controls her pain, it doesn't address her anxiety,crying, calling out in fear at being alone, constant feeling to void, (HX ofUTI and I know the morphine probably exacerbates that) etc.

    I relayed info to attending MD and received an order for anti-anxiety and anti-depression meds.The order was intercepted by MDS and I was told that "it took a long time to convince the family to put her on comfort care, we can't just start giving her these meds again". WHAT! This resident pushes the call light over 20times during the night shift. She has become enough of a distraction to her roommate that she has requested a room change just to get some sleep.

    My CNA's get tied up with her understandably needy behavior and pull precious time away from other residents while we're short staffed. I am totally disoriented this morning trying to wrap my head around the term "comfort care" and the obvious lack of comfort for my resident. Being new, I'm wondering if I'm missing something here? or is the MDS for some reason trying to control the nursing care he initiated? could this be a money issue? is this common practice because it seems inhumane to me?

    I thought I was to advocate for my patient and this morning I basically got my hand slapped for requesting meds to help her with symptoms other than her pain.
    Last edit by Esme12 on Mar 31, '13 : Reason: formatting
  2. Visit  RN 033 profile page

    About RN 033

    From 'southern California'; Joined Jan '11; Posts: 40; Likes: 38.

    12 Comments so far...

  3. Visit  ixchel profile page
    1
    Oh, love This doesn't seem right to me. I'm still a student, so I don't know, but I thought that comfort care was simply stopping any life-sustaining treatment and promoting comfort (relieving pain, emotionally and physically). It seems the exact opposite of promoting comfort to take away medications that may support her emotionally. That is truly unfortunate, and I hope that this has a more compassionate ending.
    prnqday likes this.
  4. Visit  lkulmann profile page
    0
    How about making the patient comfortable? A Foley and more morphine maybe?
  5. Visit  chrisrn24 profile page
    5
    Anti anxiety meds are not prolonging life, they are absolutely indicated for situations where the resident has anxiety.
  6. Visit  LPNBearColumbus profile page
    3
    An order for an anti anxiety med would absolutely be considered comfort care. As would placement of a foley if the resident has urinary retention or urgency. Is the patient on hospice yet? If not, it's more than appropriate to get social services involved and have them talk to the family about hospice care. I'm willing to bet that a hospice nurse would get this resident a rx for Ativan Intensol (liquid ativan drops) in a heartbeat.
  7. Visit  mappers profile page
    2
    This sounds completely wrong to me. Sounds like your facility (MD or MDS maybe) doesn't understand the theory behind comfort care. See if you can't get a trained palliative care person involved.
    sallyrnrrt and ktwlpn like this.
  8. Visit  VioletKaliLPN profile page
    1
    Perhaps the anti depressants may be a 'no', but I will 2nd the Ativan Intensol.

    I currently have a comfort care pt on both. All anti depressants were dc'd, other meds, etc, she is doing well with the routine. As well as she can, she is a woman dying of cancer.
    prnqday likes this.
  9. Visit  Nascar nurse profile page
    0
    You are not missing anything here. Comfort care if about comfort and if a resident is this anxious they are NOT comfortable. If the resident was on hospice care, the hospice nurse would have them on an antianxiety medication in a heart beat. Your MDS person must be a little nuts (and I did MDS for 10 years).

    Go to your DON and see if you can get some support to get the MDS person to back off.
  10. Visit  lovingtheunloved profile page
    2
    Clearly your MDS person is nuts. Comfort care is exactly what it sounds like.
    Daisy_08 and KelRN215 like this.
  11. Visit  NurseCard profile page
    0
    I just "second" everything that has been said. Liquid Morphine and Liquid Ativan is what this lady needs!
  12. Visit  ktwlpn profile page
    0
    Anti- depressants are indicated too-we will only d/c them when the resident is in the dying trajectory and having difficulty swallowing(same for thyroid meds,anti HTN's,insulin etc although the goal for blood sugar coverage is much more liberal).If she is having urinary retention she needs a foley,if the feeling of needing to void continues an antibiotic can be considered palliative care. I have learned over the years that sometimes the best way to get things like this done is to have the request originate from the family,then you are out of the line of fire from peers and other depts. The MDS nurse knows the family well but needs someeducation regarding palliative care.DNR or comfort care does NOT mean DO NOT TREAT
  13. Visit  KelRN215 profile page
    0
    Comfort care means keeping the patient comfortable. It sounds like this patient is not. I agree with all the previous suggestions.
  14. Visit  prnqday profile page
    1
    OP you are correct and I'm not sure why MDS is challenging you on this. When I worked in LTC and had actively dying patients, we would administer morphine, Ativan and an anti-cholinergic around the clock and that was it.
    sallyrnrrt likes this.


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