Improving implantable cardioverter defibrillator deactivation discussions in admitted patients made DNR and comfort care

[摘要] Background Unintended shocks from implantablecardioverter defibrillators (ICDs) are often distressing topatients and family members, particularly at the end oflife. Unfortunately, a large proportion of ICDs remain activeat the time of death among do not resuscitate (DNR) andcomfort care patients.Methods We designed standardised teaching sessionsfor providers and implemented a novel decision tool in theelectronic medical record (EMR) to improve the frequencyof discussions surrounding ICD deactivation over a6-month period. The intended population was patientson inpatient medicine and cardiology services made DNRand/or comfort care. These rates were compared withretrospective data from 6months prior to our interventions.Results After our interventions, the rates of discussionsregarding deactivation of ICDs improved from 50% to 93%in comfort care patients and from 32% to 70% in DNRpatients. The rates of deactivated ICDs improved from 45%to 73% in comfort care patients and from 29% to 40% inDNR patients.Conclusion Standardised education of healthcareproviders and decision support tools and reminders in theEMR system are effective ways to increase awareness,discussion and deactivation of ICDs in comfort care andDNR patients.

[学科分类] 药学