Considerations for a comfort care order set: Communication, regular care, and patient monitoring
| Indication | Order examples | Considerations |
|---|---|---|
| Communication | ||
| Nursing communication | Check on patient every 2 hours for signs of distress including grimacing or changes in mentation or breathing | Change from traditional vital signs to monitoring patient for comfort during dying process Clinicians should ask to be alerted for any uncontrolled symptoms despite appropriate medication administration |
| Code status | Comfort care Do not resuscitate or intubate | Ensure patient, family, and nursing team are aware of plan States may have additional nuanced code status options; clinicians should ensure they are familiar with those available to them |
| Regular care and patient monitoring | ||
| Room ambiance | Open blinds and turn on lights during day; close blinds and turn lights off at night Consider placing television to comforting music channel Place comfort care cart at bedside | All should be at patient or caregiver preference Depending on hospital protocol, cart or sign may be placed outside door to indicate shift in care to staff |
| Patient assistance | Turn patient every 2 hours to maintain comfort Assist patient with movement as appropriate Assist patient with toileting as appropriate | Customize orders to patient condition and preference Consider whether foley catheter or other toileting devices can aid in patient comfort |
| Wound care | Reconsult wound care specialist for recommendations in setting of comfort care with goal of maximum comfort to wound | Transitioning wound care to focus on comfort rather than healing may result in fewer bandage changes or changing materials used Emphasize in communication that the body does not have the energy to heal, and care will be directed to minimizing pain or other discomfort, such as odor, from wounds |
| Physical and occupational therapy | Provide recommendations for therapy with goal of maximum comfort | Transition may include recommendations for passive movement to avoid contractures and pain, as well as massage Encourage families to learn and be involved, as able |
| Vital signs | Discontinue vital sign monitoring Monitor vital signs only on patient or family request | Explain to patient and family that care will be determined based on physical examination and patient symptoms rather than numerical data |
| Oxygen use, titration | Discontinue supplemental oxygen Continue oxygen at current level, but do not increase | Consider stopping entirely, not titrating up, or setting a limit to titration Coach families and staff around plans to use for symptoms rather than to meet an oxygen saturation goal |
| Other monitoring | Blood glucose: continue, change frequency, or discontinue blood glucose checks Fluid status: discontinue or continue daily weights; allow patient to drink according to thirst | Patients accustomed to close monitoring may require repeated discussions and stepwise changes in care |
Based on information from references 10–12.