"Do not resuscitate" does not mean "do not treat," but hospitals can struggle to manage the suffering of patients who do not want aggressive intervention in an effective and timely manner, according to Melissa Perrell Phipps, assistant general counsel for Novant Health, and John D. Phipps, M.D., executive vice president of Novant Health and president of Novant Health medical group.
In a recent post for Harvard Business Review, the Phipps describe Novant's adoption of a solution known as "Code Comfort." An idea that originated with one of the health system's palliative care managers, Code Comfort is like a Code Blue in that it's treated with the same urgency. But instead of triggering CPR, intubation, paddles or other aggressive lifesaving measures, the goal of Code Comfort is to provide immediate, aggressive relief of suffering.
Using this clearly defined rapid response process, nurses and other frontline staff follow algorithm-driven methods to address symptoms such as pain, agitation and dyspnea in dying or critically ill DNR patients. For example, nurses would respond to a patient suffering from severe, acute dyspnea with morphine, with increased oxygen, by elevating his or her head or other measures to reduce anxiety, according to the post.
During a Code Comfort, the post notes, nurses are always present to address the needs of patients as well as family members. Other team members who may be called upon to provide physical or emotional support include palliative care physicians, nurses, respiratory therapists, chaplains or other appropriately trained personnel.
To learn more:
- read the post