February 2009

How to Abstract Comfort Measures Only

By Mary Jane McCracken, RN

Do you have trouble abstracting the Comfort Measures Only (CMO) data element? You’re not alone – it’s considered to be one of the most confusing data abstraction elements. Even worse, your hospital’s validation score may hinge on how you answer it. Follow the steps below for foolproof abstraction of CMO.

Step 1 - Put yourself in the Clinical Data Abstraction Center’s (CDAC) shoes.
Many hospital abstractors are nurses, yet many of the CDAC abstractors are not, thus creating a knowledge imbalance. Nurses have the benefit of clinical knowledge when abstracting the chart, while CDAC takes the chart strictly at face value.

Step 2 - Refer to the data dictionary in the Specifications Manual.
Many of you rely solely on your vendor abstraction tool. CDAC does not have access to your vendor’s database. Instead, CDAC uses the Specifications Manual found on www.qualitynet.org. Make sure you use the latest version of the Specification Manual that corresponds to the discharge quarter you’re abstracting. There are also “General Abstraction Guidelines” found in the introduction to the data dictionary that contain information related to all data definitions.

Step 3 - Read the CMO data element pages in the appropriate version of the data dictionary.
 The Definition states that only physician/APN/PA documentation is acceptable. Under the Notes for Abstraction, the first bulleted item reads: “Only accept terms identified in the list of inclusions. No other terminology will be accepted.”

Step 4 - Pay special attention to the List of Inclusions.
As stated in Step 3, these are the ONLY words/phrases that count as documentation of CMO:

• Allow natural death
• Comfort care
• Comfort measures
• Comfort measures only (CMO)
• Comfort only
• End of life care
• Hospice
• Hospice care
• Palliative care
• Palliative measures
• Terminal care

CDAC abstractors take the chart at face value. They search for words on the inclusions list instead of reading the chart. This is also true regarding the wording on any standardized form signed by the physician, including forms generated for DNR by the state of North Carolina.

Step 5 – Pay close attention to the Notes for Abstraction.
When answering “When is the earliest documentation of Comfort Measures Only” note the earliest date that the inclusion terms are found, not the actual date that comfort measures are ordered. This is crucial in identifying if arrival measures will be evaluated. Look for them used in a context of consideration, consult, or family request as comfort measures.

Finally, if there is any doubt at all or the documentation is questionable or vague, go to www.qualitynet.org and download a PDF copy or Excel copy of the Quest database. If you don’t find your question answered there, you can post a question on the Quest website – www.qnetquest.org. It’s also been recommended that you bypass your vendor’s skip logic and over abstract for all measures.

Editor’s note: Mary Jane McCracken is the General Manager of Clinical-Insights in Cary, North Carolina.

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