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Improving rates of implantable cardioverter defibrillator deactivation in end-of-life care

Implantable cardioverter defibrillators (ICDs) save lives in selected patients at risk of sudden cardiac death. However, in patents suffering with terminal illness, ICD therapy could pose a risk of unnecessary futile shocks which could lead to undignified discomfort in their final days of life. Nati...

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Autores principales: Javaid, MR, Squirrell, Suzanne, Farooqi, Fahad
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5922560/
https://www.ncbi.nlm.nih.gov/pubmed/29713689
http://dx.doi.org/10.1136/bmjoq-2017-000254
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author Javaid, MR
Squirrell, Suzanne
Farooqi, Fahad
author_facet Javaid, MR
Squirrell, Suzanne
Farooqi, Fahad
author_sort Javaid, MR
collection PubMed
description Implantable cardioverter defibrillators (ICDs) save lives in selected patients at risk of sudden cardiac death. However, in patents suffering with terminal illness, ICD therapy could pose a risk of unnecessary futile shocks which could lead to undignified discomfort in their final days of life. National guidelines advise that patients approaching the end of their natural life should be offered a compassionate choice of having their defibrillator deactivated. Following an actual clinical incident involving a patient receiving avoidable ICD shocks in his final hours, we identified shortcomings in communication and gaps in knowledge about ICD management in end-of-life care. We developed a quality improvement programme targeting training and educational support to general physicians and nurses at our large District General Hospital. A series of interventions were delivered including Grand Round presentation, departmental seminars and publicity posters. In parallel, we introduced a local protocol for implementing ICD deactivation which was published on our intranet for Trust-wide accessibility. Following interventions, we examined the clinical notes of each end-of-life care patient who died with an ICD in situ over a 6-month observation period and recorded the proportion who received consent-guided ICD deactivation versus died with an active ICD in situ because no deactivation discussion had been offered. Before our interventions in 2015, 0 out of 10 eligible patients (0%) received consent-guided ICD deactivation. Six months into our campaign to encourage healthcare workers to undertake advance care planning discussion in 2016, 7 out of 13 eligible patients (54%) received consent-guided ICD deactivation and no patients received shocks in their final month of life. This programme was successful in raising awareness of this emerging issue, improving physician knowledge and delivering patient choice as well as contributing to safe and compassionate end-of-life care.
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spelling pubmed-59225602018-04-30 Improving rates of implantable cardioverter defibrillator deactivation in end-of-life care Javaid, MR Squirrell, Suzanne Farooqi, Fahad BMJ Open Qual BMJ Quality Improvement Report Implantable cardioverter defibrillators (ICDs) save lives in selected patients at risk of sudden cardiac death. However, in patents suffering with terminal illness, ICD therapy could pose a risk of unnecessary futile shocks which could lead to undignified discomfort in their final days of life. National guidelines advise that patients approaching the end of their natural life should be offered a compassionate choice of having their defibrillator deactivated. Following an actual clinical incident involving a patient receiving avoidable ICD shocks in his final hours, we identified shortcomings in communication and gaps in knowledge about ICD management in end-of-life care. We developed a quality improvement programme targeting training and educational support to general physicians and nurses at our large District General Hospital. A series of interventions were delivered including Grand Round presentation, departmental seminars and publicity posters. In parallel, we introduced a local protocol for implementing ICD deactivation which was published on our intranet for Trust-wide accessibility. Following interventions, we examined the clinical notes of each end-of-life care patient who died with an ICD in situ over a 6-month observation period and recorded the proportion who received consent-guided ICD deactivation versus died with an active ICD in situ because no deactivation discussion had been offered. Before our interventions in 2015, 0 out of 10 eligible patients (0%) received consent-guided ICD deactivation. Six months into our campaign to encourage healthcare workers to undertake advance care planning discussion in 2016, 7 out of 13 eligible patients (54%) received consent-guided ICD deactivation and no patients received shocks in their final month of life. This programme was successful in raising awareness of this emerging issue, improving physician knowledge and delivering patient choice as well as contributing to safe and compassionate end-of-life care. BMJ Publishing Group 2018-04-25 /pmc/articles/PMC5922560/ /pubmed/29713689 http://dx.doi.org/10.1136/bmjoq-2017-000254 Text en © Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle BMJ Quality Improvement Report
Javaid, MR
Squirrell, Suzanne
Farooqi, Fahad
Improving rates of implantable cardioverter defibrillator deactivation in end-of-life care
title Improving rates of implantable cardioverter defibrillator deactivation in end-of-life care
title_full Improving rates of implantable cardioverter defibrillator deactivation in end-of-life care
title_fullStr Improving rates of implantable cardioverter defibrillator deactivation in end-of-life care
title_full_unstemmed Improving rates of implantable cardioverter defibrillator deactivation in end-of-life care
title_short Improving rates of implantable cardioverter defibrillator deactivation in end-of-life care
title_sort improving rates of implantable cardioverter defibrillator deactivation in end-of-life care
topic BMJ Quality Improvement Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5922560/
https://www.ncbi.nlm.nih.gov/pubmed/29713689
http://dx.doi.org/10.1136/bmjoq-2017-000254
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