What constitutes "comfort care" at your hospital?

[CrazierThanYou]

I recently changed jobs from one hospital to another. I am baffled by many differences and one of them is "comfort care".

At my old hospital, patient who were on comfort care were kept comfortable. No vital signs, no neuro checks, usually only pain and anxiety medications were given. At my new hospital, a patient is deemed "comfort care" but its obviously in name only. Vitals are done, regular medications are given. There is virtually NOTHING different from the care we would give any other patient.

So, how is it done where you work?

[sistrmoon, BSN, RN]

No vitals, no labs, all meds are discontinued except pain and anxiety meds. Turns can be refused by the family. Usually on a drip. Oxygen only for comfort. We get a lot of these on Oncology because we are essentially inpatient hospice. In fact, I once got a comfort care patient from another floor because they weren't comfortable caring for the patient.

[SoldierNurse22, BSN, RN]

Same as above. We've had comfort care patients who have continued to receive chemotherapy as it's been noted that it was keeping some of their nastier oncology symptoms at bay (preventing the growth of bone cancer/retinoblastomas and therefore reducing pain), but it was only for the comfort of the patient.

Sounds like your hospital needs some education in comfort care, OP.

Introduction | National Institute on Aging

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2988455/

http://www.aacn.org/wd/palliative/content/eolcare-domain5.pcms?menu=practice

The last resource is one you may find particularly helpful.

Eliminate unnecessary tests and procedures (lab work, weights, routine vital

signs, etc.), and only maintain IVs for symptom management in situations where

life-support is being withdrawn:

• Develop protocol to ensure consistent implementation.
  

[classicdame, MSN, EdD]

please be sure you have orders specifying what is to be done or not done, unless your facility has a policy. You bring up a good point - that people may consider different things as comfort measures. In my state there are laws regarding palliative care (to protect the patient). If the MD has not ordered palliative care then certain measures may be considered harmful, such as not turning every 2 hours or stopping most of the meds. At any rate, it is outside the nurse's scope of practice to D/C any regimen, so the blanket order "provide comfort care" is really asking you to act outside your scope. Just be sure there is a policy or accurate orders or both.

[CrazierThanYou]

Thank you for your replies. That's what I thought.

At my previous hospital there were specific orders regarding discontinuation of various kinds of care. At the current hospital, as I previously stated, there is virtually no difference in care.

[ChristineN, BSN, RN]

We don't have a protocol per say, but it is generally accepted that if a pt is comfort care IV fluids are stopped, daily labs are d/c'ed, daily meds are stopped, and if you are doing vital signs you are generally only recording respirations.

[loriangel14, RN]

Our comfort care includes pain meds, sedation,personal and mouth care plus turning. We also will continue po meds if the doctor wishes as long as the patient can swallow. we have patients that will will be on comfort measures but still alert and oriented.

[classicdame, MSN, EdD]

ChristineN: So if you do not have standing orders or protocol where is your documentation that you made the best decision for your patient? I would ask the Risk Manager or someone in Admin about this, as you would be left holding the bag if a family member decides you are not doing "all you can do" to make their loved one comfortable. The nurses need a policy to support any decisions they make on their own, as long as it does not conflict with the BON.

[ChristineN, BSN, RN]

ChristineN: So if you do not have standing orders or protocol where is your documentation that you made the best decision for your patient? I would ask the Risk Manager or someone in Admin about this as you would be left holding the bag if a family member decides you are not doing "all you can do" to make their loved one comfortable. The nurses need a policy to support any decisions they make on their own, as long as it does not conflict with the BON.[/quote']

It is up to each doctor to order what they want. I will say I feel many times I feel the doctors wait to long to make someone comfort care

[CrazierThanYou]

It is up to each doctor to order what they want. I will say I feel many times I feel the doctors wait to long to make someone comfort care

I agree. We have one hospitalist who thinks he can save everyone, no matter what the medical issues are.

[ChristineN, BSN, RN]

I agree. We have one hospitalist who thinks he can save everyone, no matter what the medical issues are.

Since I work ER I don't have to deal with this side of things much anymore, but the worst was when I had an elderly pt, actively dying, family at bedside, and hospitalist insisting the pt needed to be admitted to a tele floor. Why?!

[nrsang97, BSN, RN]

Our comfort care is no labs, no x rays, etc. Vitals once a shift or once a day depending on doctor order. Morphine drip or dilaudid drip, PRN roxanol, and ativan. Oxygen for comfort as well. Mouth care, turning q2h or prn.