Best practices for End of life care And Comfort care Order sets for our Nation’s veterans
Comfort Care Order Set (CCOS) has been developed to improve the processes of care for veterans at end-of-life or dying both in the acute care wards and CLCs (nursing homes) of VA Medical Centers. Care of the dying in inpatient settings is an important aspect of improving care in the hospital in general and improving care for hospice and palliative care patients at life’s end.
Comfort Care Order Set Implementation Introduction
Build a Comfort Care Order Set (Instructions of each of the components of the CCOS so that the PCCT and CPRS can build the CCOS at their facility)
Presentation of Comfort Care Order Set to in-service physician, nursing and all other staff in hospital when CCOS is activated
Sample of "Preparing for Your Loved One's Loss"
Sample PDF Version of Pocket Cards for BEACON Project
Sample Chart Abstraction Tool that can be used to devise CQI projects
Bailey FA, Williams BR, Goode PS, Kennedy RE, Redden DT, Kvale E, Bakitas M, Dionne-Odom JN, Burgio KL. Comparison of Two Methods for Implementing Comfort Care Order Sets in the Inpatient Setting: a Cluster Randomized Trial. J Gen Intern Med. 2021 Feb 5. doi: 10.1007/s11606-020-06482-x. Epub ahead of print. PMID: 33547573.
Bailey FA, Williams BR, Woodby LL, Goode PS, Redden DT, Houston TK, Granstaff US, Johnson TM 2nd, Pennypacker LC, Haddock KS, Painter JM, Spencer JM, Hartney T, Burgio KL. Intervention to improve care at life's end in inpatient settings: the BEACON trial. J Gen Intern Med. 2014 Jun;29(6):836-43. doi: 10.1007/s11606-013-2724-6. PMID: 24449032; PMCID: PMC4026508.
Bailey FA, Burgio KL, Woodby LL, Williams BR, Redden DT, Kovac SH, Durham RM, Goode PS. Improving processes of hospital care during the last hours of life. Arch Intern Med. 2005 Aug 8-22;165(15):1722-7. doi: 10.1001/archinte.165.15.1722. PMID: 16087819.
Williams BR, Amos Bailey F, Kvale E, Steil N, Goode PS, Kennedy RE, Burgio KL. Continuation of non-essential medications in actively dying hospitalised patients. BMJ Support Palliat Care. 2017 Dec;7(4):450-457. doi: 10.1136/bmjspcare-2016-001229. Epub 2017 Sep 13. PMID: 28904011.
Bailey FA, Allen RS, Williams BR, Goode PS, Granstaff S, Redden DT, Burgio KL. Do-not-resuscitate orders in the last days of life. J Palliat Med. 2012 Jul;15(7):751-9. doi: 10.1089/jpm.2011.0321. Epub 2012 Apr 26. PMID: 22536938.
Bailey FA, Williams BR, Goode PS, Woodby LL, Redden DT, Johnson TM 2nd, Taylor JW, Burgio KL. Opioid pain medication orders and administration in the last days of life. J Pain Symptom Manage. 2012 Nov;44(5):681-91. doi: 10.1016/j.jpainsymman.2011.11.006. Epub 2012 Jul 4. PMID: 22765968.
Williams BR, Bailey FA, Goode PS, Kvale EA, Slay LA, Bakitas MA, Burgio KL. "Online Training Is Great but Human Interaction Is Better": Training Preferences of VA Interdisciplinary Palliative Care Consult Teams. Am J Hosp Palliat Care. 2020 Oct;37(10):800-808. doi: 10.1177/1049909120907599. Epub 2020 Mar 3. PMID: 32122166.
Wittich AR, Williams BR, Bailey FA, Woodby LL, Burgio KL. "He got his last wishes": ways of knowing a loved one's end-of-life preferences and whether those preferences were honored. J Clin Ethics. 2013 Summer;24(2):113-24. PMID: 23923810.
Williams BR, Bailey FA, Noh H, Woodby LL, Wittich AR, Burgio KL. "I was ready to take him home": next-of-kin's accounts of loved one's death during hospice and palliative care discussions in Veterans Affairs Medical Centers. J Soc Work End Life Palliat Care. 2015;11(1):50-73. doi: 10.1080/15524256.2015.1021070. PMID: 25869147
Riggs JS, Woodby LL, Burgio KL, Bailey FA, Williams BR. "Don't get weak in your compassion": bereaved next of kin's suggestions for improving end-of-life care in Veterans Affairs Medical Centers. J Am Geriatr Soc. 2014 Apr;62(4):642-8. doi: 10.1111/jgs.12764.
Epub 2014 Mar 21. PMID: 24655157.
Williams BR, Bailey FA, Woodby LL, Wittich AR, Burgio KL. "A room full of chairs around his bed": being present at the death of a loved one in Veterans Affairs Medical Centers. Omega (Westport). 2012-2013;66(3):231-63. doi: 10.2190/om.66.3.c. PMID: 23617101.
Drentea P, Williams BR, Bailey FA, Burgio KL. "He's on his dying bed": Next- of-kin's experiences of the dying body. Death Stud. 2016;40(1):1-10. doi: 10.1080/07481187.2015.1056565. Epub 2015 Jun 18. PMID: 26086748.
Williams BR, Woodby LL, Bailey FA, Burgio KL. Formative evaluation of a multi-component, education-based intervention to improve processes of end-of- life care. Gerontol Geriatr Educ. 2014;35(1):4-22. doi: 10.1080/02701960.2013.858334. PMID: 24228744.
Williams BR, Woodby LL, Bailey FA, Burgio KL. Identifying and responding to ethical and methodological issues in after-death interviews with next-of-kin. Death Stud. 2008;32(3):197-236. doi: 10.1080/07481180701881297. PMID: 18705168.
For assistance with clinical application and testing of the CCOS:
F. Amos Bailey MD
Co-PI BEACON Project
For questions regarding the policy and procedures section of the appendix:
Voncyle Mahone RN
Nurse Manager, Safe Harbor Palliative Care Unit
700 S 19th Street
Birmingham, AL 35233