Evaluations of Adaptations to a Comfort Care Order Set: A Retrospective Cohort Review

Background: Comfort care order sets support evidence-based best practices that promote high-quality end-of-life care through mitigation of physical symptoms associated with the dying process. Pain and dyspnea are among the most common symptoms at the end of life, for which opioids are the mainstay of treatment. Sublingual (SL) formulations of opioids are often utilized in hospice care, though there are no available data comparing the efficacy of this route compared to oral or intravenous (IV) routes. Due to concern for medication shortages during the COVID-19 pandemic, the comfort care order set at our institution was modified to recommend initial opioid management with SL rather than IV medication. This study aimed to characterize opioid use by patients utilizing the comfort care order set before and after this change was made.