Comfort Care

This article is about collecting the "Comfort care" (ACP C, palliation) temp entry.

Data Use and Purpose

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.

We do not want to track patients for whom comfort care is ordered after admission.

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

Start and stop date

• Start Date: 2013-Nov-11
• Stop Date: none

Collection Instructions for Medicine and ICU

NOTE....don't need to mark check box in column B if comfort care Project and Item are selected in TMP. Redundant step. Trish Ostryzniuk 20:11, 2013 November 27 (CST)

• Where: ccmdb TMP L_TmpV2:
  • PROJECT: Select from dropdown list : Comfort Care
  • ITEM: Select from dropdown list: Comfort Care

1. 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 (i)-(iii) require that the patient was ACP-C or that the Palliative Care Service be involved in care.

• None of the other fields in tmp are used for this project, ie no dates etc.

Admit DX's would use the same process as we always do. Most significant Medical problem in admit 1, 2, 3 etc.

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

Example

Patient 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

Data use / Reporting and Analysis

I will populate this when I finally catch the report... Ttenbergen 15:06, 2014 September 19 (CDT)

The data is used to exclude patients from analysis for Project Overstay.

The data is used to exclude patients in the analysis of the ALERT Score in the quarter and yearly Reports.