Providing Comfort Care for Hospitalized Patients

Guidelines for Physicians Providing Comfort Care for Hospitalized Patients Who Are Near the End of Life.

• Ideally, the dying process should never entail sustained severe pain or other physical suffering. The physician should assure the patient and family that comfort is a high priority and that troubling symptoms will be expertly treated.

• When possible, involve an interdisciplinary team that offers comprehensive, coordinated care for both the patient and the family. Promote good communication among the members of the clinical team.

• Nursing interventions (e.g., oral care, skin and wound care, application of heat or cold packs) can be critical in addressing the full range of the patient’s and family members’ needs, as can attention from mental health providers, social workers, music therapists, volunteers, and others.

• Inquire about the patient’s spiritual and religious needs (“Is religion or spirituality important to you?”) and offer chaplaincy services when appropriate.

• Discontinue diagnostic or treatment efforts that are likely to have negligible benefit or that may cause harm by diminishing the patient’s quality of life and his or her ability to interact with loved ones. Monitoring of vital signs is rarely useful in the final days of life, especially when obtaining this information involves the use of noisy, distracting monitors in the patient’s room. Unnecessary treatment with medications not intended for comfort (such as statins for hyperlipidemia) should be discontinued.19 Mouth and skin care and changing the patient’s position in bed may enhance comfort in some situations, but in other situations these measures may bother the patient and contribute to suffering and should be discontinued.

• Prophylactic analgesia or sedation should be administered before distressing procedures are performed (e.g., removal of a chest tube, withdrawal of mechanical ventilation in a conscious patient, or changing the dressing on a pressure sore). Treating the symptoms associated with such procedures only after they occur is likely to lead to unnecessary discomfort until the appropriate medication takes effect.

• Encourage oral assisted eating for pleasure but respectfully inform patients and families that the administration of intravenous fluids and nutrition through a feeding tube has no benefit in terms of comfort or survival at this phase of illness.

• Inform the patient and family about any proposed major changes in the management of the patient’s condition.

• Consider home care, rather than care in the hospital, for the patient if appropriate. Most dying patients are more physically comfortable at home, and family members have generally been found to be most satisfied with the experience of relatives who die at home with hospice care.

Source

IKA SYAMSUL HUDA MZ