Comfort care protocol.

allnurses Guide · May 14, 2021

Comfort care orders I have worked with say every 2 hours PRN for pain/anxiety. So no it's not scheduled it's PRN. My mother was on comfort care and never received morphine.

MunoRN, RN · May 14, 2021

There are a number of validated pain and agitation scales for use in end-of-life care that PRN medication should be based on. Indicators of distress that aren't captured by these scales can still be assessed for and should drive the decision to give these medications. That doesn't mean that pre-emptive medicating or medicating because these factors truly can't be assessed is never appropriate, but a broad rule that everyone on comfort care should be given an opiate and a benzo every 2 hours isn't appropriate.

CABGpatch_RN, BSN · May 14, 2021

17 minutes ago, taly12 said:

I feel that I would actually be helping the patient go faster.

I too would not medicate an individual who I can objectively assess isn't uncomfortable.....bp good, rr good and unlabored, no grimacing when touched or nudged, not agitated or restless, etc etc. Your assessment is your assessment. Be confident with it.

I would urge you however to talk through these feelings that these meds prompt or hasten death with someone experienced in palliative or comfort care. I think while acknowledging your thoughts, you need to ditch them. I personally don't want a nurse who thinks this way.

amoLucia · May 14, 2021

I retired from LTC 2010. And YES, I would medicate pts even if I could NOT discern any discomfort.

At the time, we didn't have the 'heavy duty' opiate/benzo protocols; nor any fancy assessment scales/tools. I just didn't want any of my pts uncomfortable, whether they could tell me or not, and whether or not I could determine any great distress.

I made sure all of those kind of pts rec'd SOMETHING mild, even if only Tylenol. And I made sure they were well positioned, turned, clean & dry, looked neat.

Usually, the previous nurse and the following nurses rarely medicated these pts 'JUST BECAUSE' like I would. It has always been my wish that NO family or friends of mine would ever be in a condition that made the decision questionable; that some nurse would take the initiative to try & make sure all was as well as poss.

LovingLife123 · May 16, 2021

Yes, you give it in my opinion. If I’m dying, I don’t want to be the least bit aware. It disturbs me when people try to use a CPOT of RASS to give medication in end of life. Just give the medication in reasonable intervals.

Ask yourself this question, do you want to lay there dying knowing that you are dying and scared, or do you want a nice, calm, peaceful death? The whole hastening their death is bogus. They are in fact dying, the family has agreed that they are dying, and has decided to let go. They are not getting any type of life saving treatment. No nutrition, no fluids, no oxygen.

My orders are for morphine q20 minutes and Ativan q1h. I give it all as frequently as I can for the first couple of hours. Then I back off depending on the patients breathing and give medications at the very least q1h.

This is one of my soapboxes. I have coworkers that won’t medicate and I think it’s cruel. In all my years of ICU care have I ever hastened a death.

amoLucia · May 16, 2021

LovingLife123 - TY. I would appreciate having you as the nurse for me or mine.

When I was working LTC, I always wondered if maybe I MISSED a slight facial grimace as I was turning a pt. Or I maybe missed a slight 'oomph groan' during that turn.

Like I said, my medications were usually very simple. (Altho I have admin sq morphine thru a site.) My charting took a kind of 'creative bent'. Like I would chart 'pt medicated with 650 mg Tylenol for general discomfort/comfort' No one ever challenged my decision. Even when I needed to touch base with families for updates, I would tell them about the 'tylenol, JUST BECAUSE'.