Improving the transition to comfort measures only at a community hospital

Purpose of the Project: Comprehensive and compassionate end-of-life (EOL) care requires high quality communication between healthcare disciplines, effective documentation of the care plan during the transition to Comfort Measures Only (CMO), and staff confidence that symptoms are adequately managed at EOL. This quality improvement project sought to address these needs by implementing a CMO checklist during the transition to EOL care in a community hospital ICU. Objectives were to improve communication within the interdisciplinary team (IDT), improve staff confidence that patient symptoms were managed well at EOL, and increase the completeness of documentation during the transition to CMO. Methods: Interventions included staff education, implementation of a CMO checklist during patient transition to EOL care, and pre and post implementation assessments of the objectives via staff surveys and chart reviews. Results: Findings demonstrated statistically significant (p<.001) improvements in staff confidence in symptom management and effective communication within the IDT, as well as a statistically significant (p= .005) increase in the comprehensiveness of documentation post implementation. Staff feedback identified barriers such as accessibility of paper checklist and competing priorities to documentation. Implications for Practice: This project highlights the potential value of using protocol-driven approaches in improving quality of care at EOL and suggests opportunities for broader implementation. Recommendations include integration of the checklist into the electronic medical record (EMR), continuing staff education, and ongoing leadership support.Keywords: end-of-life, comfort measures only, ICU protocols, interdisciplinary team, communication, transition of care, documentation standards, symptom management