Comfort Care DNR protocol

When a patient is in a non-hospital setting, Emergency Medical Technicians (EMTs) are required to provide emergency medical care and to transport patients to appropriate health care facilities. Emergency Medical Services (EMS) personnel are required by law to provide treatment to the fullest extent possible, subject to their level of training.

Comfort Care DNR Order Verification Protocol (Comfort and Care DNR)

1. The Comfort Care DNR is designed to allow EMTs and first responders to honor a DNR order in an out-of-hospital setting.
2. Before 1999, when Massachusetts implemented its Comfort Care DNR protocol, there was no mechanism to enable EMT’s and other first responders to recognize DNR orders in a non-hospital setting. So EMT personnel were always obligated to perform full resuscitation measures when they encountered a patient unable to convey directions regarding medical treatment.
3. The Comfort Care DNR protocol provides for a statewide, uniform DNR verification protocol.
4. The purpose of the Comfort Care DNR is to: (a) provide a verification of DNR orders to enable EMTs and first responders to honor DNR orders, (b) clarify the role and responsibilities of EMTs and first responders at the scene and/or during transport of patients who have a valid current DNR order, (c) avoid resuscitation of patients who have a current and valid DNR, (d) provide for palliative/comfort care measures for patients with a current Comfort Care DNR order verification form.
5. Comfort Care DNR order verification forms must be completed and signed by the patient’s physician, authorized Physician’s Assistant or Nurse Practitioner.
6. The patient must post the Comfort Care DNR where any EMT or first responder can easily find it. (Usually the patient’s refrigerator, or taped to the patients bedroom door. The Department of Public Health stopped issuing Comfort Care DNR bracelets in 2007, but the Department’s approved form contains bracelet inserts that can be used in generic wrist bracelets.
7. The Comfort Care DNR Order Verification form can be accessed by anyone, in downloadable format from the Massachusetts Department of Public Health/Office of Emergency Medical Services website, at: http://www.mass.gov/eohhs/gov/departments/dph/programs/hcq/oems/comfort-care/public-health-oems-comfort-care-verification.html. But the form must be fully completed and signed by the attending physician, authorized nurse practitioner or authorized physician assistant as proscribed by the regulations.

Comfort Care Order (CCO-DNR) program Plus MOLST

EMS Comfort Care Order Do Not Resuscitate Program | doh

The
Emergency Medical Services (EMS) Comfort Care Order-Do Not Resuscitate
(CCO-DNR) program allows patients diagnosed with a specific medical or
terminal condition to express their wishes regarding end of life
resuscitation in the pre or post-hospital setting.


The program requires that a patient’s attending physician certify and sign a Comfort Care Order
(CCO) that states the patient (adult or child) has a specific medical
or terminal condition. The patient, or his or her authorized decision
maker or surrogate, must also consent and sign the CCO (verbal orders
are not valid). The physician then places a Comfort Care bracelet on the
patien

Resources | Novant Health | Choices and Champions

Resources | Novant Health | Choices and Champions
Novant Health is a integrated system of physician practices, hospitals, outpatient centers, and more – each element committed to delivering a remarkable healthcare experience for you and your family.

• Aging with Dignity
• American Bar Association Consumer’s Toolkit for Healthcare Advance Planning
• American Bar Association: Myths and Facts about Health Care Advance Directives
• American Bar Association smartphone app for advance directives
• BeginTheConversation.org
• Caring Connections
• The Conversation Project
• Donate Life America
• Engage with Grace
• Get Palliative Care
• A Gift to Your Family
• The Go Wish game
• It's OK to Die When You Are Prepared
• MedlinePlus
• Moments of Life
• N.C. Partnership for Compassionate Care
• OrganDonor.gov
• South Carolina Advance Care Planning: Isn’t It Time We Talked?

Code Comfort is for patients with a DNR order who desire comfort measures. Use of the order set will promote comfort for patients at risk for symptom crisis nearing end of life. Code Comfort Order Set Code Comfort Policy (draft)

Code Comfort: A Code Blue Alternative for Patients with DNRs - HBR

Code Comfort: A Code Blue Alternative for Patients with DNRs - HBR



Code Comfort provides a response for patients whose code status is
DNR and who desire comfort measures only. It is a compassionate way to
manage pain and suffering — including emotional suffering — during an
acute crisis without providing unwanted care. Hospital staff responding
to a Code Comfort may include palliative care physicians, nurses,
respiratory therapists, chaplains and others who are prepared to rapidly
address the patient’s physical symptoms, as well as the suffering and
concerns of family members.




As is true for CPR efforts, we know teamwork matters to relieve the
suffering of dying patients. Code Comfort protocols include an
algorithm-driven method for assessing and addressing symptoms such as
pain, agitation and dyspnea. For example, a patient suffering from
severe, acute dyspnea would be given morphine and increased oxygen, her
head would be elevated, a fan might be used to provide a comforting
breeze, and she’d receive other measures to reduce anxiety. Importantly,
Code Comfort ensures that no patient or family suffers alone. Nurses
are present during the code, actively treating the patient’s symptoms
and calling in other team members as needed, all of which provides
essential emotional support and reassurance



 Code Comfort: A Code Blue Alternative for Patients with DNRs
Melissa P. Phipps, John D. Phipps; December 9, 2014

19 Free Services for Seniors or Their Caregivers - AgingCare.com

19 Free Services for Seniors or Their Caregivers - AgingCare.com