Comfort Measures Only (v2021A)

Specifications Manual for Joint Commission National Quality Measures (v2021A)

Posted: 7/29/2020

Home » Comfort Measures Only

Release Notes:
Data Element
Version 2021A

Name:

Comfort Measures Only

Collected For:

ACHF, ASR-IP-2, ASR-IP-3, ASR-OP-2, CCCIP-01, CCCIP-02, CCCIP-03, CCCIP-04, CCCOP-01, CCCOP-02, CSTK-01, CSTK-03, CSTK-04, CSTK-06, STK-1, STK-10, STK-2, STK-3, STK-5, STK-6, STK-8, STK-OP-1, SUB-2, SUB-3, TOB-2, TOB-3, VTE-6

Definition:

Comfort Measures Only refers to medical treatment of a dying person where the natural dying process is permitted to occur while assuring maximum comfort. It includes attention to the psychological and spiritual needs of the patient and support for both the dying patient and the patient's family. Comfort Measures Only is commonly referred to as “comfort care” by the general public. It is not equivalent to a physician order to withhold emergency resuscitative measures such as Do Not Resuscitate (DNR).

Question:

When is the earliest physician/APN/PA documentation of comfort measures only?

Format:

Length:	1
Type:	Alphanumeric
Occurs:	1

Allowable Values:

1 Day 0 or 1: The earliest day the physician/APN/PA documented comfort measures only was the day of arrival (Day 0) or day after arrival (Day 1).

2 Day 2 or after: The earliest day the physician/APN/PA documented comfort measures only was two or more days after arrival day (Day 2+).

3 Timing unclear: There is physician/APN/PA documentation of comfort measures only during this hospital stay, but whether the earliest documentation of comfort measures only was on day 0 or 1 OR after day 1 is unclear.

4 Not Documented/UTD: There is no physician/APN/PA documentation of comfort measures only, or unable to determine from medical record documentation.

Notes for Abstraction:

Only accept terms identified in the list of inclusions. No other terminology will be accepted.
Physician/APN/PA documentation of comfort measures only (hospice, comfort care, etc.) mentioned in the following contexts suffices:
- Comfort measures only recommendation
- Order for consultation or evaluation by a hospice care service
- Patient or family request for comfort measures only
- Plan for comfort measures only
- Referral to hospice care service
- Discussion of comfort measures
Determine the earliest day comfort measures only (CMO) was DOCUMENTED by the physician/APN/PA. If any of the inclusion terms are documented by the physician/APN/PA, select value “1,” “2,” or “3” accordingly.
Examples:
"Discussed comfort care with family on arrival" noted in day 2 progress note -— Select “2.”"
State-Authorized Portable Orders (SAPOs).
- SAPOs are specialized forms or identifiers authorized by state law that translate a patient”s preferences about specific end-of-life treatment decisions into portable medical orders
  Examples:
  - DNR-Comfort Care form
  - MOLST (Medical Orders for Life-Sustaining Treatment)
  - POLST (Physician Orders for Life-Sustaining Treatment)
  - Out-of-Hospital DNR (OOH DNR)
- If there is a SAPO in the record that is dated and signed prior to arrival with an option in which an inclusion term is found that is checked, select value “1.”
- If a SAPO lists different options for CMO and any CMO option is checked, select value “1,” “2,”" or “3”" as applicable.
- If one or more dated SAPOs are included in the record (and signed by the physician/APN/PA), use only the most recent one. Disregard undated SAPOs.
- For cases where there is a SAPO in the record with a CMO option selected: If the SAPO is dated prior to arrival and there is documentation on the day of arrival or the day after arrival that the patient does not want CMO, and there is no other documentation regarding CMO found in the record, disregard the SAPO.
  Example:
  Patient has a POLST dated prior to arrival in his chart and ED physician states in current record “Patient is refusing comfort measures, wants to receive full treatment and be a full code.”
Documentation of an inclusion term in the following situations should be disregarded. Continue to review the remaining physician/APN/PA documentation for acceptable inclusion terms. If the ONLY documentation found is an inclusion term in the following situations, select value “4.”"
- Documentation (other than SAPOs) that is dated prior to arrival or documentation which refers to the pre-arrival time period.
  Examples:
  - Comfort measures only order in previous hospitalization record.
  - “Pt. on hospice at home” in MD ED note.
- Inclusion term clearly described as negative or conditional.
  Examples:
  - “No comfort care"
  - "Not appropriate for hospice care"
  - “Comfort care would also be reasonable - defer decision for now”"
  - “DNRCCA”" (Do Not Resuscitate -— Comfort Care Arrest)
  - “Family requests comfort measures only should the patient arrest.”
- Documentation of “CMO”" should be disregarded if documentation makes clear it is not being used as an acronym for Comfort Measures Only (e.g., “hx dilated CMO” -— Cardiomyopathy context).
If there is physician/APN/PA documentation of an inclusion term in one source that indicates the patient is Comfort Measures Only, AND there is physician/APN/PA documentation of an inclusion term in another source that indicates the patient is NOT CMO, the source that indicates the patient is CMO would be used to select value “1,” “2,” or “3”" for this data element.
Examples:
- Physician documents in progress note on day 1 “The patient has refused Comfort Measures” AND then on day 2 the physician writes an order for a Hospice referral. Select value “2.”
- ED physician documents in a note on day of arrival “Patient states they want to be enrolled in Hospice” AND then on day 2 there is a physician progress note with documentation of “Patient is not a Hospice candidate.” Select value “1.”

Suggested Data Sources:

PHYSICIAN/APN/PA DOCUMENTATION ONLY IN THE FOLLOWING ONLY ACCEPTBLE SOURCES:

Consultation notes
Discharge summary
DNR/MOLST/POLST forms
Emergency department record
History and physical
Physician orders
Progress notes

Additional Notes:

Excluded Data Sources:

Restraint order sheet

Guidelines for Abstraction:

Inclusion

Exclusion

Brain dead
Brain death
Comfort care
Comfort measures
Comfort measures only (CMO)
Comfort only
DNR-CC
End of life care
Hospice
Hospice care
Organ harvest
Terminal care
Terminal extubation

None

Specifications Manual for Joint Commission National Quality Measures (v2021A)
Discharges 01-01-21 (1Q21) through 06-30-21 (2Q21)

LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION (“CPT®”)

You, your employees and agents are authorized to use CPT® only as contained in The Joint Commission performance measures solely for your own personal use in directly participating in healthcare programs administered by The Joint Commission. You acknowledge that the American Medical Association (“AMA”) holds all copyright, trademark and other rights in CPT®.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT® for resale and/or license, transferring copies of CPT® to any party not bound by this Agreement, creating any modified or derivative work of CPT®, or making any commercial use of CPT®. License to use CPT® for any use not authorized herein must be obtained through the American Medical Association, Intellectual Property Services, AMA Plaza, 330 North Wabash Avenue, Suite 39300, Chicago, Illinois 60611-5885. Applications are available at the American Medical Association Web site, www.ama- assn.org/go/cpt.

U.S. Government Rights This product includes CPT® which is commercial technical data, which was developed exclusively at private expense by the American Medical Association, 330 North Wabash Avenue, Chicago, Illinois 60611. The American Medical Association does not agree to license CPT® to the Federal Government based on the license in FAR 52.227-14 (Data Rights - General) and DFARS 252.227-7015 (Technical Data - Commercial Items) or any other license provision. The American Medical Association reserves all rights to approve any license with any Federal agency.

Disclaimer of Warranties and Liabilities. CPT® is provided “as is” without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT®, and the (AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this product is with The Joint Commission, and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product.

This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.

Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by clicking below on the button labeled “accept”.