Comfort Care: Difference between revisions

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Not implemented yet.
{{Project
|ProjectActive=legacy
|ProjectProgram=CC and Med
|ProjectRequestor=Internal
|ProjectCollectionStartDate=2013-11-11
|ProjectCollectionStopDate=2019-08-26
|Project={{PAGENAME}}
}}
{{LegacyContent
|explanation=This concept is now essentially a twin of [[Palliative care]], so collection no longer needed.  
|successor=[[Palliative care]]
|content=


===Data Use and Purpose===
This article is about collecting the "Comfort care" ([[ACP C]], [[Palliative care]]) temp entry. Collection has stopped, see [[Palliative care]] for a related thing we collect.
The purpose of adding this to TMP is allow '''medicine program''' to identify those patients whom the plan ''upon ward admission'' is comfort care only.'''


==Coming to a laptop near you soon: TMP STUDY ==
== Data Use and Purpose ==
=== Project Name ===
=== Which patients qualify ===
{{Discussion}}
The purpose is to specifically identify and tag '''only''' those ICU and Medicine patients for whom the '''initial goal''' of care right from the start of a unit admission is comfort care, [[ACP C]], palliation.


*needs a project & item name in TMP - Collectors any '''suggestions''' for '''Project name''' in TMP that would be intuitive to all? We can change article name if better idea comes forward.[[User:TOstryzniuk|Trish Ostryzniuk]] 19:55, 2013 October 23 (CDT)
Pts for whom comfort care is ordered '''after admission do ''not'' qualify.'''
** To keep the entries a reasonable length in the temp tap, do you think "end-of-life" would work as a project name, and as the entry name? Ttenbergen 11:22, 2013 October 28 (CDT)
***Data collector, please advise what would be intuitive and clear to all on laptop.[[User:TOstryzniuk|Trish Ostryzniuk]] 11:29, 2013 October 28 (CDT)
****Comfort Care would be more intuitive as End-of-Life suggests actively discontinuing treatment which we never do on Medicine (apparently.--[[User:CMarks|CMarks]] 12:38, 2013 October 28 (CDT)
*****thank Con.  That sound perfect.[[User:TOstryzniuk|Trish Ostryzniuk]] 18:38, 2013 October 28 (CDT)


=== Collection Instruction ===
Pt '''does not require''' but could be receiving [[Palliative Service]]'''.
{{Discussion}}
We created a TMP entry so that the medicine program can identify those patients whom the ''plan upon medicine ward admission'' was for comfort care only.  This information can be obtain from the resident or physician initial admission notes or order.[[User:TOstryzniuk|Trish Ostryzniuk]] 18:38, 2013 October 28 (CDT)
*The way I understood it is that you would code this independent from diagnoses. The primary admit dx would be whatever is most responsible medically for having you there. In other words, this would get rid of the "special case" collection instructions for palliative care. At the latest we would need to do this anyway when we move to ICD, no? Ttenbergen 11:22, 2013 October 28 (CDT)
***We have never seen a physician document the primary reason for admission as comfort/end of life care. In the orders you may see comfort care only but generally it is obvious that the patient is admitted to die in hospital. Because of this, we must use our own discretion.--[[User:CMarks|CMarks]] 12:15, 2013 October 28 (CDT)
**** I have never seen the primary reason for admission from ER  written by a physician as Comfort/End of life even when pt is enrolled in pallitative care program.  The only time I have seen this is when the pt is D/C treatment ex: massive CVA or admitted from MICU for D/C treatment.--[[User:PStein|PStein]] 12:25, 2013 October 28 (CDT)
*I have had patients admitted primarily for end of life/palliative care but who would now not qualify for coding for Palliative Care under the new definition. --[[User:SCortilet|SCortilet]] 12:32, 2013 October 28 (CDT)
**Stephanie, that is correct. You would put medical issue as reason for admit DX code and in TMP you would tag as comfort care. [[User:TOstryzniuk|Trish Ostryzniuk]] 18:16, 2013 October 28 (CDT)


Pt ''could'' be receiving some medical treatments like treating an pneumonia or infection, pain, dehydration and anything else that would ease suffering.


===Other questions===
Select Comfort Care only if '''any''' of the following are true:  
Need to clarify if comfort care is the only reason admitted to hospital. Can the patient have any other issues that are being treated? (ie. pneumonia or wound infection, etc.)?? --[[User:LKolesar|LKolesar]] 09:13, 2013 October 24 (CDT)  
*(a) the patient had an ACP-C ''prior to'' admission to that unit/ward
*Comfort/end of life care is only to be recorded in TMP if a physician documents in the chart that the plan upon ward admission was comfort care only.  If physician does not record this in the chart then comfort care should not be recorded in TMP .[[User:TOstryzniuk|Trish Ostryzniuk]] 18:16, 2013 October 28 (CDT)
*(b) the patient had an ACP-C order implemented as ''part of'' the admission orders to that unit/ward
**Need to clarify:  to use this tmp selection does Dr Roberts just want pts where the plan on admission is comfort care '''only''' (with no treatment for any other conditions) OR does he want comfort care as a "primary problem" with treatment for other conditions OK as well. There is a big difference.  A pt may be terminal but may be coming to hospital for treatment of an infection OR the pt may be coming to hospital for only comfort care (ie.for pain or nausea that is not being managed well at home).  Whether the pt dies while in hospital is never predictable because there are always some who will go home to die in any situation.  I think he may want only those people who come JUST for comfort care in which event we need to make this clear.  --[[User:LKolesar|LKolesar]] 14:44, 2013 October 28 (CDT)
*(c) the ''initial admission note'' of the unit/ward attending physician and/or the H&P written by the house officer identifies that the patient was admitted for any of: 
**Dr. Roberts intent is to identify patient for whom the PLAN UPON WARD ADMISSION, was for comfort care only.
**(i) comfort care,  
**(ii) palliation
**(iii) palliative care
**(iv) or end-of-life care   
***Note that none of items (ii)-(iv) require that the patient was ACP-C or that the Palliative Care Service be involved in care.


==Instructions==
=== Coding Instructions ===
*In TMP: Medicine Collectors to enter “Admit for: comfort care only if and only if:
If the patient meets the above criteria then code as:
**intention in the initial ward admission note written by the ward resident or attending physician documents explicitly that the care plan for the patient upon ward admission is for the purpose of providing, comfort care only.
*In [[CCMDB.accdb]] '''TMP''' tab add:
**Do not enter this into TMP if the decision is made by the physician '''later''' on during the ward admission.
**PROJECT: Comfort Care
{{Discussion}}
**ITEM: Comfort Care
*** the decision to declare a pt as comfort care only is usually not made till the pt has been there for 48 hours Judy 28,Oct 2013
**Checkbox, dates, numbers: Don't need to fill, not used for this project


{{Data Integrity Check List|}}


== Data use / Reporting and Analysis ==
The data is used to exclude patients in the analysis of the [[ALERT Scale]] in the [[Directors Quarterly and Annual Report (Medicine)]].


[[Category:All Projects Medicine Only]]
== Related articles ==
{{Related Articles}}
 
[[Category:End-of-life related data]]
}}

Latest revision as of 20:06, 2022 February 17

Projects
Active?: legacy
Program: CC and Med
Requestor: Internal
Collection start: 2013-11-11
Collection end: 2019-08-26

Legacy Content

This page contains Legacy Content.

Click Expand to show legacy content.

This article is about collecting the "Comfort care" (ACP C, Palliative care) temp entry. Collection has stopped, see Palliative care for a related thing we collect.

Data Use and Purpose

Which patients qualify

The purpose is to specifically identify and tag only those ICU and Medicine patients for whom the initial goal of care right from the start of a unit admission is comfort care, ACP C, palliation.

Pts for whom comfort care is ordered after admission do not qualify.

Pt does not require but could be receiving Palliative Service.

Pt could be receiving some medical treatments like treating an pneumonia or infection, pain, dehydration and anything else that would ease suffering.

Select Comfort Care only if any of the following are true:

  • (a) the patient had an ACP-C prior to admission to that unit/ward
  • (b) the patient had an ACP-C order implemented as part of the admission orders to that unit/ward
  • (c) the initial admission note of the unit/ward attending physician and/or the H&P written by the house officer identifies that the patient was admitted for any of:
    • (i) comfort care,
    • (ii) palliation
    • (iii) palliative care
    • (iv) or end-of-life care
      • Note that none of items (ii)-(iv) require that the patient was ACP-C or that the Palliative Care Service be involved in care.

Coding Instructions

If the patient meets the above criteria then code as:

  • In CCMDB.accdb TMP tab add:
    • PROJECT: Comfort Care
    • ITEM: Comfort Care
    • Checkbox, dates, numbers: Don't need to fill, not used for this project

Data Integrity Checks (automatic list)

 AppStatus
Query s tmp comfort care gt oneCCMDB.accdbretired

Data use / Reporting and Analysis

The data is used to exclude patients in the analysis of the ALERT Scale in the Directors Quarterly and Annual Report (Medicine).

Related articles

Related articles:
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