A New Generation of Comfort Care Order Sets: Aligning Protocols with Current Principles

Bender, Melissa; Hurd, Caroline; Solvang, Nicole; Colagrossi, Kathy; Matsuwaka, Diane; Curtis, J. Randall

doi:10.1089/jpm.2016.0549

Cited by 21 publications

(12 citation statements)

References 25 publications

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“…7,8,13,14 We revised our institution's comfort care order set to create resources to individualize comfort care and align it with current pharmacologic principles. 10 The differences in moral distress between nurses and providers found in our and other studies might be further explained by the different roles these clinicians have in end-of-life care. Providers are more likely to be involved in medical decisionmaking around when to transition to comfort care and managing comfort care orders, including opioids.…”

Section: Discussionmentioning

confidence: 54%

“…7,8,13,14 We revised our institution’s comfort care order set to create resources to individualize comfort care and align it with current pharmacologic principles. 10…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9] We reported on the revision of our institution's comfort care order set based on the following concerns (1) the nursing algorithm allowed rapid escalation of intravenous opioid infusions (every 30 minutes as needed) that sometimes caused increased discomfort (ie, opioid-induced hyperalgesia) and had the potential to hasten death, and (2) it was based on outdated practices of sedation and analgesia in intensive care unit (ICU) settings. 10 Concerns with comfort care order sets have the potential to exacerbate clinician moral distress. We found no published reports on moral distress using a comfort care order set.…”

Section: Introductionmentioning

confidence: 99%

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Moral Distress and Attitudes About Timing Related to Comfort Care for Hospitalized Patients: A Survey of Inpatient Providers and Nurses

Bender

Andrilla

Sharma

et al. 2019

Am J Hosp Palliat Care

Self Cite

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Context: Providing nonbeneficial care at the end of life and delays in initiating comfort care have been associated with provider and nurse moral distress. Objective: Evaluate provider and nurse moral distress when using a comfort care order set and attitudes about timing of initiating comfort care for hospitalized patients. Methods: Cross-sectional survey of providers (physicians, nurse practitioners, and physician assistants) and nurses at 2 large academic hospitals in 2015. Providers and nurses were surveyed about their experiences providing comfort care in an inpatient setting. Results: Two hundred five nurse and 124 provider surveys were analyzed. A greater proportion of nurses compared to providers reported experiencing moral distress “some, most, or all of the time” when using the comfort care order set (40.5% and 19.4%, respectively, P = .002). Over 60% of nurses and providers reported comfort care was generally started too late in a patient’s course, with physician trainees (81.4%), as well as providers (80.9%) and nurses (84.0%) < 5 years from graduating professional school most likely to report that comfort care is generally started too late. Conclusions: The majority of providers and nurses reported that comfort care was started too late in a patient’s course. Nurses experienced higher levels of moral distress than providers when caring for patients using a comfort care order set. Further research is needed to determine what is driving this moral distress in order to tailor interventions for nurses and providers.

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Section: Discussionmentioning

confidence: 54%

“…7,8,13,14 We revised our institution’s comfort care order set to create resources to individualize comfort care and align it with current pharmacologic principles. 10…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Moral Distress and Attitudes About Timing Related to Comfort Care for Hospitalized Patients: A Survey of Inpatient Providers and Nurses

Bender

Andrilla

Sharma

et al. 2019

Am J Hosp Palliat Care

Self Cite

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“…There are a few reports of the efficacy of an order set in treating patients at the end of life, both to improve symptom control and to increase adherence to current standards in palliative care treatment [13,14,15]. In a pilot study of children at the end of life, Houlahan et al have reported the use of rapid titration templates, among other strategies, to reduce the burden associated with rapid escalation of pain, dyspnea, and agitation [8].…”

Section: Discussionmentioning

confidence: 99%

Clinical Use of an Order Protocol for Distress in Pediatric Palliative Care

et al. 2019

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Several children receiving palliative care experience dyspnea and pain. An order protocol for distress (OPD) is available at Sainte-Justine Hospital, aimed at alleviating respiratory distress, pain and anxiety in pediatric palliative care patients. This study evaluates the clinical use of the OPD at Sainte-Justine Hospital, through a retrospective chart review of all patients for whom the OPD was prescribed between September 2009 and September 2012. Effectiveness of the OPD was assessed using chart documentation of the patient’s symptoms, or the modified Borg scale. Safety of the OPD was evaluated by measuring the time between administration of the first medication and the patient’s death, and clinical evolution of the patient as recorded in the chart. One hundred and four (104) patients were included in the study. The OPD was administered at least once to 78 (75%) patients. A total of 350 episodes of administration occurred, mainly for respiratory distress (89%). Relief was provided in 90% of cases. The interval between administration of the first protocol and death was 17 h; the interval was longer in children with cancer compared to other illnesses (p = 0.02). Data from this study support the effectiveness and safety of using an OPD for children receiving palliative care.

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“…Although more than 50% of Canadians die in acute care hospitals (Statistics Canada, 2018), gaps exist in the care provided to hospitalized patients at the end of life (Bender et al, 2017). End of life (EOL) care has been defined as the support and medical care patients and families receive during the time surrounding death (Razmaria, 2016).…”

Section: Introductionmentioning

confidence: 99%

The Role of Spiritual Care with the Introduction of an End of Life Order Set

Stilos

Ford

Lilien

et al. 2019

J Pastoral Care Counsel

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Delivering comprehensive end-of-life care to dying patients must involve addressing physical symptoms and psychosocial concerns. Care pathways have been introduced to support health care teams in delivering this care. This retrospective chart review explores the contributions of the Spiritual Care Team in the care of dying patients. They offer a range of interventions which include supportive care, religious and spiritual support. This study was one step towards appreciating the contributions of the Spiritual Care Team.

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A New Generation of Comfort Care Order Sets: Aligning Protocols with Current Principles

Abstract: We successfully developed a new comfort care order set at our institutions that can serve as a resource for others. Further evaluation of this order set is needed.

Cited by 21 publications

References 25 publications

Moral Distress and Attitudes About Timing Related to Comfort Care for Hospitalized Patients: A Survey of Inpatient Providers and Nurses

Moral Distress and Attitudes About Timing Related to Comfort Care for Hospitalized Patients: A Survey of Inpatient Providers and Nurses

Clinical Use of an Order Protocol for Distress in Pediatric Palliative Care

The Role of Spiritual Care with the Introduction of an End of Life Order Set

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