what is comfort care only?

Specialties Geriatric

Published

hello

i'm confused :confused: about advanced directive. what does it mean to you when the advanced directive states "comfort care only?" does it mean patient can be medically treated? does it also mean patient can have iv fluid?

Specializes in GERIATRICS, DEMENTIA CARE, MED-SURG.

MY patient last night 101 female BG 33 O2 sat 79 on 3l temp 99, respirations inthe 40's pulse 110 and upwards...............call the doc he suggests haha ER....we just wanted ms to help with pain and breathing.............

Just hypothetically, is it common for a patient to be on comfort care and for the family to come in and suddenly change the plan by asking for life-saving interventions llike defib or intubation? What about insulin or glucagon, is it ever appropriate to let a client on comfort care have a blood glucose of 39 or 400?

I imagine that emotions can be strong when people are actually seeing their loved one slip away, and all bets are off at some point. In such situations they might rethink their position on comfort care no matter what they agreed upon earlier.

Specializes in CNA.

At my facility comfort care is: pain meds, O2 if needed, repositioning, pericare, skin care and oral care. Fluids and nutrition are offered, but patient refusal is not a ...concern, worry, big deal (not really sure how to word that?). Some patients do not want antibiotics when on comfort care also. They do not want any heroic measures done to save their lives. Basically comfort care is just keeping the patient out of pain and peaceful until they pass.

I also think giving the family and patient privacy and not going in there a 100 times a shift makes sense. Aides do their best, but undo interruptions are not comforting to dying patients.

Specializes in Geriatric/Sub Acute, Home Care.

Anything that keeps the patient comfortable and what is ordered by the doctor that the nurse feels they may need. All of which should be documented and written in the care plan as needed. Whether it be comfort foods, more blankets at night, pain meds, basic needs every resident should have really but they stress it more for some strange reason during times of undue stress, severe illness, hospice cases, or if the patient has mental issues. I never knew why it was put that way either. Just another way to say something I guess.

An advance directive needs to be specific. Usually this involves a power of attorney for health care and/or a living will. If you aren't sure then you can call the MD and get a clarification.

Specializes in Home Health/Hospice.

Our advance directovers state what they want. Usually is the pt. is comfort care we do comfort care with PRN ativan or PRN morphine. Usually VS are not done but i usually do O2 sats and resps. 02 is usually used for comfort. The key is to make sure they are comfortable. I had a pt. who need MS more than q6 hours so I called the doc to do every 1hour prn. I'm the nurse who usually gives MS on the dot if they are on their way dying. It's a matter of comfort, if they are comfortalbe via objective analysis then you're good, if they are not then call your MD for comfort measures.

Specializes in LTC.

I have a resident who was recently put on comfort care this week. Shes not actively dying. The nurse who put the order in said that with comfort care lab draws are dc'd.

Then yesterday I was going through the presents from 7-3 and there was a lab draw in and when I notified the doctor of the results she said to do a redraw next week and I remember she was on comfort care and I wasn't sure if she got labs so the doctor said to flag it for her monday morning.

I looked up the policy and procedure on comfort care. I couldn't find one. Are labs supposed to be dc'd? I'll bring this up next time I work because I want to know for next time.

Specializes in LTC, Hospice, Case Management.
I have a resident who was recently put on comfort care this week. Shes not actively dying. The nurse who put the order in said that with comfort care lab draws are dc'd.

Then yesterday I was going through the presents from 7-3 and there was a lab draw in and when I notified the doctor of the results she said to do a redraw next week and I remember she was on comfort care and I wasn't sure if she got labs so the doctor said to flag it for her monday morning.

I looked up the policy and procedure on comfort care. I couldn't find one. Are labs supposed to be dc'd? I'll bring this up next time I work because I want to know for next time.

I think it will all be an individual consideration. It will depend on what meds they are on, what the family/resident expectation is, etc.

Most often I try to explain to the family why the Dr. may want the labs done and let them make the decision. After that I call the MD and state family wants us to "blah, blah, blah" is that Ok with you. Of course, you would carefully document both conversations to cover your butt.

Examples - "Mom is still getting Coumadin everyday and Dr wants us to keep checking her INR level every ___ weeks. It's pretty important we do this if she stays on the coumadin because we need to monitor that her blood isn't getting to thin and then she could get into bleeding problems".

Versus - "We all have been aware for sometime that Mom has cancer of her colon and needs surgery. You and the Dr. have agreed not to put her thru that and just allow her to be comfortable. We are still monitoring her blood counts every week. Do you want her to continue this every week even though she will not be having any treatment"?

Specializes in Geri, psych, TCU, neuro--AKA LTC.

Our LTCF has a Comfort Care Directive that spells it out in writing about hospitalization, transfusions, suctioning, IV fluids, meds, antibiotics (oral, injectable, or IV), labs, other testing, even oxygen, etc. Ideally if the patient is alert and oriented and able to express their own wishes, we ask them to discuss it with family and physician, fill it out and sign it. If not, we ask the family to discuss it and fill it out if they wish with the explanation that making decisions now when Mom or Dad is not ill is likely MUCH easier than an emergent situation.

We've had situations in which we sent a resident to ER d/t acute change in mental and physical status. We sent every page in Advance Directives section of chart including Comfort Care Directive (CCD). This gentleman was septic, and because he had documented HIS wishes on CCD, family and MD were spared the difficult decision-making at that time. His family and the ER MD were very appreciative that we knew exactly what HE wanted for his care, and were able to communicate that very concisely. Our medical director shared this with us as it was shared with him by the ER MD.

Our facility is now a part of a multi-facility chain and we've shared this with other facilities and our local hospice. If you're interested in developing your own, I'm absolutely willing to share what we have. Just let me know.

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