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Quick summary: Lauren Vater, MD, MPH witnessed something she never hopes she'll witness again. A quick share on how to ensure a comfortable death for the inevitable, when possible.

On my fifth day as an intern, I witnessed something I hope to never witness again.

One of my team members removed a breathing tube (the patient and family had decided to focus on comfort), but the nurse was at lunch.

She was not alerted this was happening.

There were no comfort medications ordered, or mention of these orders.

Then our team moved on to the next patient for rounds.

 

When the nurse returned, the patient was uncomfortable.

There were no medication orders.

 

I witnessed something I hope to never witness again.

 

It took time to get the orders.

It took time to get the medicines verified/pulled/transported.

All of this precious time.

The nurse was distressed.

The family was distressed.

I was distressed.

 

One of my team members removed a breathing tube (the patient and family had decided to focus on comfort), but the nurse was at lunch. When the nurse returned, the patient was uncomfortable. Click To Tweet

 

Let’s ensure our patients on comfort care measures really have a peaceful death.

Here’s how to help a patient die peacefully:

Before removing the breathing tube, ask:

 

  1. Does my patient have medication ordered to keep her comfortable (comfort care order set)?
  2. Is the nursing team aware of the plan?
  3. Is the respiratory therapist aware of the plan?
  4. Does the nurse have quick access to medication to ease pain and difficulty breathing, or is more time needed for it to be verified/delivered?

 

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Lauren Vater, MD, MPH

Laura Vater, MD, MPH is an oncology fellow, writer, and speaker.

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