Comfort Care

Not implemented yet.

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.

Coming to a laptop near you soon: TMP STUDY

Project Name

• 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.Trish Ostryzniuk 19:55, 2013 October 23 (CDT)
  • 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.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.--CMarks 12:38, 2013 October 28 (CDT)
        • thank Con. That sound perfect.Trish Ostryzniuk 18:38, 2013 October 28 (CDT)

Collection Instruction

Template: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.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.--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.--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. --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. Trish Ostryzniuk 18:16, 2013 October 28 (CDT)

Other questions

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.)?? --LKolesar 09:13, 2013 October 24 (CDT)

• 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 .Trish Ostryzniuk 18:16, 2013 October 28 (CDT)
  • 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. --LKolesar 14:44, 2013 October 28 (CDT)
  • Dr. Roberts intent is to identify patient for whom the PLAN UPON WARD ADMISSION, was for comfort care only.

Instructions

• In TMP: Medicine Collectors to enter “Admit for: comfort care only if and only if:
  • 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.
  • Do not enter this into TMP if the decision is made by the physician later on during the ward admission.

• • • 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