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| Not implemented yet. | | Not implemented yet. Coming to a laptop near you soon: TMP STUDY |
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| | Comfort care, ACP C, palliation |
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| ===Data Use and Purpose=== | | ===Data Use and Purpose=== |
| The purpose of adding this to TMP is allow the '''medicine program''' to identify those patients whom the plan ''upon ward admission'' is comfort care only.''' | | The purpose of adding this to TMP is allow the '''medicine program''' to identify those patients whom the ''initial intent of care AT the start of a ward admission'' is: comfort care, ACP C, palliation. |
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| | NOTE: Palliation does not mean consult to palliative care service, but can include it. See [[Palliative Care Service]] |
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| ==Coming to a laptop near you soon: TMP STUDY == | | === Collection Instructions === |
| === Project Name === | | #A ward admitting physician/resident's order/note is required to be present on chart stating: comfort care, ACP C, palliation |
| {{Discussion}}
| | #*Project Name: Admit Intent |
| | #*Item: Comfort Care |
| | #Admit DX would use the same process as we always do. Most significant Medical problem in admit 1, 2, 3 etc. |
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| *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)
| | Note: Comfort care, ACP C, palliation all mean that the ''INTENT of care at the time of ward admission'' is comfort care. This does not preclude having some medical treatments like treating an pneumonia or infection. |
| ** 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)
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| ***Data collector, please advise what would be intuitive and clear to all on laptop.[[User:TOstryzniuk|Trish Ostryzniuk]] 11:29, 2013 October 28 (CDT)
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| ****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)
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| *****thank Con. That sound perfect.[[User:TOstryzniuk|Trish Ostryzniuk]] 18:38, 2013 October 28 (CDT)
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| === Collection Instruction ===
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| {{Discussion}}
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| 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)
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| *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)
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| ***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)
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| **** 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)
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| *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)
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| **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)
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| ***** Hi Trish I have a question for you , a pt comes to my unit CTU/S4 for Comfort Care/ACP C I code this under TMP (comfort Care) What do I code under admission diagnosis if nothing is being treated. i.e. stroke ,cap, cancer .I know I could use pain control if they require drugs or palliative if they were consulted.But what do I use if they dont have these as an admit problem do I leave it blank? Or do you want a working diagnosis as a admit say stroke or cap?Thanks shirley
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| ***This is exactly one of the points I was trying to make. I think we should have an "ACP C" diagnostic code and one for "palliative consult". (separating the 2 codes makes sense and can still be tracked for Dr Roberts' purposes this way). Laura
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| ===Other questions===
| | 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. |
| 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)
| | *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. |
| *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)
| | *TMP |
| **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) | | **Project: Admit intent |
| **Dr. Roberts intent is to identify patient for whom the PLAN UPON WARD ADMISSION, was for comfort care only. | | **Item: Comfort Care |
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| ==Instructions==
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| *In TMP: Medicine Collectors to enter “Admit for: comfort care only if and only if:
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| **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.
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| **Do not enter this into TMP if the decision is made by the physician '''later''' on during the ward admission.
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| {{Discussion}}
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| *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
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| [[Category:All Projects Medicine Only]] | | [[Category:All Projects Medicine Only]] |
Not implemented yet. Coming to a laptop near you soon: TMP STUDY
Comfort care, ACP C, palliation
Data Use and Purpose
The purpose of adding this to TMP is allow the medicine program to identify those patients whom the initial intent of care AT the start of a ward admission is: comfort care, ACP C, palliation.
NOTE: Palliation does not mean consult to palliative care service, but can include it. See Palliative Care Service
Collection Instructions
- A ward admitting physician/resident's order/note is required to be present on chart stating: comfort care, ACP C, palliation
- Project Name: Admit Intent
- Item: Comfort Care
- Admit DX would use the same process as we always do. Most significant Medical problem in admit 1, 2, 3 etc.
Note: Comfort care, ACP C, palliation all mean that the INTENT of care at the time of ward admission is comfort care. This does not preclude having some medical treatments like treating an pneumonia or infection.
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: Admit intent
- Item: Comfort Care