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Published on: June 11, 2012
Impact of writing "comfort measures only" orders in a community teaching hospital
Kathryn A Walker1, Honesty Peltier, Renè L Mayo
1Department of Medicine, Union Memorial Hospital, Baltimore, Maryland 21218, USA. lyn.camire@medstar.net
Objectives:
We compared end-of-life care for patients with and without orders for "comfort measures only" (CMO) and evaluated whether standards for palliative medicine were met.
Design:
We retrospectively reviewed the charts of 40 patients, 20 with and 20 without a CMO order, who died in our community teaching hospital from October 2003 through September 2004. Appropriate use of medications and interventions and documentation of symptoms and family consultation were examined.
Results:
There were no significant demographic differences between the groups. Family meeting (18/20 versus 7/20, p < 0.001) and do-not-resuscitate/do-not-intubate (DNR/DNI) code status (20/20 versus 8/20; p < 0.001) occurred significantly more frequently in the CMO group. There were no other significant differences in prescribing medications or treatments. Notation of symptoms common at the end of life did not differ between the groups except for nausea/vomiting, which was more common in the non-CMO group. In the CMO group, opioids were significantly more available and antibiotics and routine laboratory work were significantly less common after the CMO order, but no other differences were observed.
Conclusion:
CMO orders alone were insufficient for redirecting changes in care at the end-of-life.
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