Non rebreather plus high flow nasal cannula for a comfort care patient?

[Aloe_sky]

I had a patient that was oriented x4 that made herself comfort measures only, she said she was tired of suffering. She was on high flow nasal cannula at 100% fio2. She called all her family in and said her goodbyes.

Prior to me starting her morphine and versed, the respiratory therapist put a non rebreather also on her which increased her O2 to high 80s. The patient wasn’t in any visible distress but her O2 was low 80s prior to(I did not take off the monitor at that point). I didn’t mention anything in front of the family but then outside the room I told the RT that was an escalation of care. She said it wasn’t and the other RTs agreed it wasn’t. They said that they can also place a bipap on her if needed. The physician assistant said “I’m not getting involved” when we all discussed our issue with the high level of oxygen. The patient was still alive for my 12 hr shift with her family members still in the room, even sleeping on the floor. 

Day shift physician comes in and says to take of the non rebreather and high flow and to place her on a nasal cannula at 2L, she died within 15minutes. They admitted there is no policy in place for how much o2 to administer during comfort measure. 

What are the practice regarding oxygen and comfort measures only patients at your hospital?

[Been there,done that, ASN, RN]

I have never been an official hospice nurse. I have hospiced my father, my best friend and many patients on  a med -surg floor. My understanding of comfort measures is....to treat the symptoms. If the patient was not exhibiting distress from air hunger , additional O2 was not required. The pulse ox should have been removed. That led to treating the monitor, not the patient.

Perhaps the mods will move this to the hospice  forum.

[JBMmom, MSN, NP]

I agree that comfort care is symptom based management, I would not have used the nonrebreather, for us that would be considered an escalation of care. If that patient were symptomatic needing more than nasal cannula, I would probably be looking for a PRN medication to alleviate symptoms. 

[tnbutterfly - Mary, BSN]

Moved to Hospice forum.