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CMO transitions, comfort measures only (CMO), critical care, end-of-life discussions, intensive care unit (ICU)



  1. Matone, Emily DNP, RN, CNL
  2. Verosky, Denise MSN, RN, CNS, ACNS-BC
  3. Siedsma, Matthew MD
  4. O'Kane, Erica N. MD, MS
  5. Ren, Dianxu MD, PhD
  6. Harlan, Melissa D. DNP, RN, ACNS-BC
  7. Tuite, Patricia K. PhD, RN, CCNS


Purpose: This quality improvement project created a guide for critical care providers transitioning patients to comfort measures only encouraging communication, collaboration, and shared decision making; ensuring management of patients' end-of-life symptoms and needs; and enhancing provider satisfaction by improving structure and consistency when transitioning patients.


Description of the Project: Interviews conducted with staff in intensive care units revealed opportunities to improve structure and processes of transitioning patients at the end of life. A subcommittee of experts designed a checklist to facilitate interdisciplinary conversations. Impact on provider satisfaction and symptom management was assessed. Presurveys circulated used a Research Electronic Data Capture tool. A checklist was implemented for 3 months, and then postsurveys were sent. Charts were audited to identify improvement in symptom management and compared with retrospective samples.


Outcomes: Clinical improvements were seen in communication (12%), collaboration (25%), shared decision making (22%), and order entry time (17%). In addition, 72% agreed the checklist improved structure and consistency; 69% reported improved communication, collaboration, and shared decision making; 61% felt it improved knowledge/understanding of patient needs; and 69% agreed it improved management of patient symptoms.


Conclusion: After checklist implementation, staff felt more involved and more comfortable, and reported more clarity in transitioning patients; no improvement in patient outcomes was realized.