Comfort Care: Difference between revisions

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


NOTE: Palliation does not mean consult to [[Palliative Care Service]], but can include it.
NOTE: Palliation, palliative care, comfort care,  does not require [[Palliative Care Service]], but can include it.


=== Collection Instructions for Medicine and ICU===
=== Collection Instructions for Medicine and ICU===
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**PROJECT: Comfort Care
**PROJECT: Comfort Care
**ITEM: Comfort Care
**ITEM: Comfort Care
#Ward physician/resident's admitting note is required to be present on the chart at the time of ward admission stating: that intent for this ward admission is for:  comfort care or ACP-C or palliation or patient status is designated as ACP-C at the start of your unit admission.
#coded as “yes” if any of the following are true:   
#*feedback from a number of staff is that we should not be relying on Doc notes because the collector see the reality that a note this specific is not often there.   
#*(a) the patient had an ACP-C ''prior to'' admission to that unit/ward
#**documentation in the patient chart that the patient care goal is ACP-C right at the start of your ward admission, then can use this information if Doc admitting note did not record this information.     
#*(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 (i)-(iii) require that the patient was ACP-C or that the Palliative Care Service be involved in care.     
#Admit DX's would use the same process as we always do.  Most significant Medical problem in admit 1, 2, 3 etc.
#Admit DX's would use the same process as we always do.  Most significant Medical problem in admit 1, 2, 3 etc.


Revision as of 17:43, 2013 November 7

Not implemented yet. Coming to a laptop near you soon: TMP STUDY

Comfort care, ACP C, palliation

Data Use and Purpose

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

NOTE: Palliation, palliative care, comfort care, does not require Palliative Care Service, but can include it.

Collection Instructions for Medicine and ICU

  • Where: ccmdb TMP:
    • PROJECT: Comfort Care
    • ITEM: Comfort Care
  1. coded as “yes” 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 (i)-(iii) require that the patient was ACP-C or that the Palliative Care Service be involved in care.
  2. Admit DX's would use the same process as we always do. Most significant Medical problem in admit 1, 2, 3 etc.

Note INTENT of care at right from the beginning of a ward admission is for comfort care, ACP C, palliation. This does not preclude having some medical treatments like treating an pneumonia or infection, pain, dehydration and anything else that would ease suffering.


Shirley Kiesmans question: pt comes to CTU/S4 with a Dr.'s note/order stated intent of care is for comfort care/ACP C. Pt has Dx of CVA, CAP, cancer.

  • Admit DX would be: 1. CVA 2. CAP, 3 CA which ever one is the primary problem first. Could be CAP because had CVA last week.
  • TMP
    • Project: Comfort Care
    • Item: Comfort Care

Other

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