Development of a Pilot Comfort Care Guideline and Education Program with an Emphasis on Continuous Opioid Infusions

Background: The hospital model of acute care is antithetical to the major underpinnings of hospice care, however many patients will die in hospitals. Clinicians are often not focused on patient comfort care and feel uneasy managing opioid infusions commonly used in EOL. The use of comfort care order sets (CCOS) have been shown to improve patient care and outcomes with EOL care in an acute care setting. Objective: Aims of this project included (a) assessment of clinician's baseline knowledge of EOL care, (b) creation of a training and education program through which to inform stakeholders about the optimal use of the CCOS in the electronic medical record (EMR), and (c) provide education regarding core principles of EOL care with an emphasis on use of the COI decision tree and algorithm. Methods: An interdisciplinary team reviewed the existing CCOS in the electronic medical record (EMR) and found it to be insufficient. A COI decision tree and algorithm adapted from another academic institution formed the basis for revisions made to COI management which is part of the CCOS. A pilot training program for clinician education was designed. Content of the education program focused on basic EOL care principals and optimal use of the CCOS and new COI decision tree and algorithm. Seventeen clinicians participated in the educational sessions over a 6 week period. Participant learning was evaluated by comparing pre- and posttest knowledge assessments before and after the education sessions. Questions assessing the usefulness and comfort with the new COI guidelines. Results: A Wilcoxon signed rank test was used to compare pre- and posttest scores. Posttest scores were found to be significantly higher than pretest scores (p = .001) indicating learning had occurred. All respondents indicated that the decision tree and algorithm would be useful in their practice and had improved their comfort with COI. Conclusion: The educational training sessions increased clinician's knowledge and comfort with the COI decision tree and algorithm. All participants indicated that it would be useful in practice. More study will need to be done to assess the effectiveness of COI management after the decision tree and algorithm are implemented with the new CCOS.