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To: Brumar89 who wrote (23989)	8/19/2012 12:54:39 PM
From: Wharf Rat	Read Replies (2) \| Respond to of 85487

"I've seen the deaths of my grandparents..." It's like global warming; your backyard doesn't adequately reflect what's going on with the planet. Did any of those relatives die on a ventilator? That's a necessary condition for pulling the plug. Download the related podcast about Death in the ICU! When physicians have decided there is nothing more they can do for a patient, they will often speak with the families and encourage them to withdraw care. Our facility actually says “Comfort Measures Only (CMO)” instead of “Withdrawing Care” because withdrawing care implies that we will no longer take care of the patient and this is not true- we do everything we can to make our patients comfortable, free from pain and anxiety and we continue to bathe and turn our patients. I have only taken care of two patients that were made CMO but there are some things that I have learned that I can share. First, the decision is made with the physicians and the family members present. Some experienced nurses are actually the ones who gently broach the subject with the family first and then bring the matter to the physicians. This is obviously going to be dependent upon how comfortable the nurse feels about the situation and the nurse’s relationship with the family. Common sense should tell you that if it is your first shift taking care of a patient that no one thinks is going to recover, you should not walk in and state your opinion to the family! Second, comfort measures only usually means turning off all vasoactive drips and taking patients off the ventilator. At our facility, there is policy that dictates what we document and how often we assess our patients. All alarms get turned off and we only monitor heart rate and O2 saturations. If I recall correctly, only one full assessment is made per shift. It is always important to obtain a copy of your hospital policy so you know exactly how to precede. newnurseblog.com