A Revised Comfort Care Order Set Incorporating Symptom Assessment Tools: A Quality Improvement Project

Abstract

Hospitalized patients in the last stages of their natural lives needed excellent symptom management to ensure comfort at the end of life. The use of Revised Comfort Care Order Set (RCCOS) that incorporated validated, evidence-based tools was paramount in guiding clinicians in recognizing, identifying and properly managing symptoms. It also served as a reminder to the clinicians to incorporate other non-pharmacological interventions such as holistic/alternative healing modalities and spiritual involvement to the standard of care of the patients at the end of life based on their discussions of patient’s goals and wishes. This was a comparative descriptive, retrospective study. The primary goal was to determine whether the revision of the comfort care order set would have an effect on the documentation and management of pain and dyspnea and increase the utilization of non- pharmacological interventions such as integrative and spiritual care in patients at the end of life. The Theory of Unpleasant Symptoms (TOUS) was used as a framework for this study. TOUS stated that the symptoms were additive and multiplicative and affected one another. If symptoms were controlled, an individual would perform better (controlled symptoms). This study showed that the RCCOS had a positive effect on the nurses’ documentation of the symptoms particularly dyspnea (x2= 44.938; p= .000). Furthermore, the documentation of reasons for administering medications was nearing statistically significant result (x2= 5.938; p= .051). The use of alternative therapies such as integrative care was improved with a statistical significant result (x2= 81.777; p= .000). The final disposition had statistically significant result (x2-20.165; p= .000). There were various limitations due to the length of time allowed with regards to the use of the RCCOS. The recommendation was to allow more time for the RCCOS use before collecting data.