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.
Old Hospital: Morphine ativan and oxygen, patient very likely to have been recently extubated, vital signs (if taken) likely to be unstable, patient very likely to die before shift is over New Hospital: ambulatory, oriented 60 year old being treated for a UTI who happens to have a DNR form on file[/quote']
Vitals only prn (at family's request), no labs, no routine meds, O2 as needed for comfort, hourly or q2hr pain/anxiolytics, scopalamine patch as needed, ok to leave foley in (if it was already there), turns as needed, eye drops, lip glycerine--We actually had a fairly comprehensive "Comfort Care" order set.
At my facility, the docs were writing "comfort measures only", but there was no policy and no other order set to go with it. It became sort of up to the nurse, which got to be a bit of a problem. Every time we needed something else for symptom management, we had to call the MD back. Some nurses thought O2 was a comfort measure, others didn't...the list goes on. Comfort measures shouldn't get redefined every shift change. So we came up with a policy that defined "comfort measures", a order set that the docs can use to customize the orders to fit the patient and situation (some pts/families want certain labs, vitals, etc) and a PowerPoint presentation to educate the staff. The nurses can use the order set as a conversation starter with the MD about what the family and patient want done and get Palliative Care or Hospice involved if appropriate. The Center for Palliative Care website (www.capc.org) has a lot of examples from other organizations.
We still do vitals, some Q4/Q8, ng tube, central lines, foleys, IV fluids, all meds, etc etc. Comfort care at my hospital is just a term clearly. I don't agree with their idea of "comfort care."
When a patient is made "comfort measures only", they're usually ordered morphine and ativan. Then it's up to the family to decide what else gets tacked on.
We ask the family if they want VS and turning. I never can figure out why they'd want VS, but you'd be surprised. Then they decide about IVF, and routine meds. I've seen comfort care pt's still receiving TPN and IV antibiotics.
I consider it a failure of our medical staff, that families aren't educated on what comfort means when a loved one is dying.
sistrmoon, BSN, RN
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