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

Area of Science:

• Palliative Care
• Medical Informatics
• Clinical Pharmacology

Background:

• Limited published comfort care order sets lead to inconsistent end-of-life symptom management.
• Existing order sets at academic medical centers caused increased patient discomfort due to rapid opioid titration and toxicity.

Purpose of the Study:

• To describe the multiyear revision process and outcomes of a standardized comfort care order set for end-of-life symptom management.
• To enhance treatment protocols for hospitalized patients requiring end-of-life care.

Main Methods:

• An interdisciplinary approach involving meetings, literature review, and expert consultation.
• Beta testing with end-users and feedback from institutional committees.
• Focus on refining opioid dosing and integrating treatment algorithms into the order set.

Main Results:

• A revised comfort care order set was developed and implemented, incorporating current pharmacologic principles and expert recommendations for opioid dosing.
• Embedded educational tools, reference materials, and prompts for interprofessional collaboration within the electronic medical record.
• The new order set aims to optimize symptom management and reduce adverse events.

Conclusions:

• A new, standardized comfort care order set was successfully developed and implemented at two academic medical centers.
• This revised order set can serve as a valuable resource for other institutions seeking to improve end-of-life care.
• Further evaluation is recommended to assess the long-term impact and effectiveness of the updated order set.