title: Impact of writing "comfort measures only" orders in a community teaching hospital.
abstract: OBJECTIVE
  We compared end-of-life care for patients with and without orders for "comfort measures only" (CMO) and evaluated whether standards for palliative medicine were met.
  
  
  METHODS
  We retrospectively reviewed the charts of 40 patients, 20 with and 20 without a CMO order, who died in our community teaching hospital from October 2003 through September 2004. Appropriate use of medications and interventions and documentation of symptoms and family consultation were examined.
  
  
  RESULTS
  There were no significant demographic differences between the groups. Family meeting (18/20 versus 7/20, p < 0.001) and do-not-resuscitate/do-not-intubate (DNR/DNI) code status (20/20 versus 8/20; p < 0.001) occurred significantly more frequently in the CMO group. There were no other significant differences in prescribing medications or treatments. Notation of symptoms common at the end of life did not differ between the groups except for nausea/vomiting, which was more common in the non-CMO group. In the CMO group, opioids were significantly more available and antibiotics and routine laboratory work were significantly less common after the CMO order, but no other differences were observed.
  
  
  CONCLUSIONS
  CMO orders alone were insufficient for redirecting changes in care at the end-of-life.
authors.affiliation: Department of Medicine, Union Memorial Hospital, Baltimore, Maryland 21218, USA. lyn.camire@medstar.net
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Walker
authors.forename: Honesty
authors.initials: H
authors.lastname: Peltier
authors.forename: Renè L
authors.initials: RL
authors.lastname: Mayo
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Kearney
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015142:Baltimore; D005260:Female; D006764:Hospitals, Community; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010166:Palliative Care / Q000458:organization & administration*; D016414:Resuscitation Orders; D012189:Retrospective Studies; D013727:Terminal Care