724

Abstract

Introduction: A staggering 1 in 5 U.S. patients will die in the intensive care unit setting. Many critical care providers and ICUs are not adequately trained or skilled at providing appropriate focused comfort measure end of life (EOL) care. We previously published our efforts at improving EOL care and goals of care discussions in the ICU setting. As part of this process, we created a focused comfort measures only, computer order entry-set (CMO/COE). Our goal is to provide patient-centered comfort care and reduce painful interventions as we allow natural death. Methods: This study was done at an academic tertiary surgical/trauma/mixed 36-bed ICU with an average of 14 deaths per month. A multidisciplinary EOL critical care team created a standardized CMO/COE with accompanying staff education prior to implementation. All comfort care patients that expired from 3 months in subsequent calendar years (to obtain cohorts of "pre" and "post" CMO order-set patients) had their charts de-identified and evaluated by an independent reviewer for specific EOL patient care. The data was subsequently compiled and compared. Results: We identified 18 deceased patients in each group. CMO/COE was shown to reduce painful interventions in 43% of patients. Of note, 7 patients in the post CMO/COE cohort group did not have the focused CMO order set used and 71% of this subgroup suffered painful interventions. Pain scores demonstrated better symptom control in 13% of patients in the CMO/COE cohort. We also noted deeper sedation scores in 11% of CMO/COE patients. Restraints were discontinued in all of the patients (100%) with the order set employed in the CMO/COE intervention group. Conclusions: A focused CMO/COE does improve EOL patient care in the critical care setting by reducing the number of painful patient interventions and discontinuing patient restraints. A trend towards improved pain and sedation symptom management was also noted in our sample.