Comfort Care Order Set VISN 11 Dissemination Project ... · VISN 11 Dissemination Project BEACON...
Transcript of Comfort Care Order Set VISN 11 Dissemination Project ... · VISN 11 Dissemination Project BEACON...
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Comfort Care Order Set VISN 11 Dissemination Project
BEACON PROJECT
Amos Bailey MDCo-PI for BEACON
Director, Palliative CareBirmingham VA
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Comfort Care Order Sets Helpful guide to care for Veterans in the hospital who
have severe and life limiting illness to improve Allows the physicians to order admission, transfer
to new unit in hospital or start order set in less than 10 minutes
Comprehensive so fewer calls for new prn medications or cross cover issues
Symptom control of pain and other symptoms Improve patient and family satisfaction
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Comfort Care Order Set Safe and Easy to use orders for pain
medications, medications for delirium and agitation and other symptoms
Prewritten nursing text orders for comfort measures that you don’t have to type in.
By using the entire order set less likely to forgot to place and order that results in call back, cross cover issues or poor symptom control.
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Writing Delayed Transfer Order
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Locating the Comfort Care Order Set
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Comfort Care Order Set
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Admit with CCOS
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Transfer with CCOS
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Diagnosis
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Condition
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Designation of Resuscitation Status
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Full Liquid Diet instead of NPO
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Full Liquid Diet:Rather than NPO
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Nursing Orders
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Vital Signs
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Suggested Notifications
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SQ Lines, IV and Fluids
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Subcutaneous Line Placement
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IV Fluids Bolus: Review
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May Choose Different Fluids
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Oxygen and Respiratory Therapy
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Oxygen Nasal Cannula Default
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Neb Therapy:If Improves Comfort
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Bed Side Fan for Air Flow
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Most Patients at Life’s End have Pain or Dyspnea and Need an Opioid
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Oral Morphine SolutionExample of Offer May Refuse
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Patient May Need Parental Medication if Problem Swallowing
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Pain Pump Continuous Rate:NO PCA if Unable to Push Button
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Haloperidol is helpful for:Delirium and Nausea/Vomiting
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Linking Laxative Therapy to Opioid Therapy
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Different Routes and Doses Depending on Age and Patient
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Haloperidol is helpful for:Delirium and Nausea/Vomiting
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Lorazepam for Anxiety and SeizureNote Different Routes/Doses for Ages
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Lorazepam ordersSQ; PRN; Delirium Warning
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Corticosteroids Often Help Multiple Symptoms
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Constipation
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Constipation
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For Death Rattle
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For Death Rattle
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Additional Comfort Orders
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Consider Consults