Simple changes can improve conduct of end-of-life care in the intensive care unit

Can J Anaesth. Jun-Jul 2004;51(6):631-6. doi: 10.1007/BF03018408.

Abstract

Purpose: To describe changes to the conduct of withdrawal of life support (WOLS) in two teaching hospital tertiary care medical surgical intensive care units (ICUs) in a single centre over two distinct time periods.

Methods: We used a retrospective chart review with a before and after comparison. We assessed aspects of end-of-life care for ICU patients dying after a WOLS before and after we introduced instruments to clarify do not resuscitate (DNR) orders and to standardize the WOLS process, sought family input into the conduct of end-of-life care, and modified physicians' orders regarding use of analgesia and sedation.

Results: One hundred thirty-eight patients died following life support withdrawal in the ICUs between July 1996 and June 1997 (PRE) and 168 patients died after a WOLS between May 1998 and April 1999 (POST). Time from ICU admission to WOLS (mean +/- SD) was shorter in the POST period (191 +/- 260 hr PRE vs 135 +/- 205 hr POST, P = 0.05). Fewer patients in the POST group received cardiopulmonary resuscitation in the 12-hr interval prior to death (PRE = 7; POST = 0: P < 0.05). Fewer comfort medications were used (PRE: 1.7 +/- 1.0 vs POST: 1.4 +/- 1.0; P < 0.05). Median cumulative dose of diazepam (PRE: 20.0 vs POST: 10.0 mg; P < 0.05) decreased. Documented involvement of physicians in WOLS discussions was unchanged but increased for pastoral care (PRE: 10/138 vs POST: 120/168 cases; P < 0.05). The majority of nurses (80%) felt that the DNR and WOLS checklists led to improved process around WOLS.

Conclusion: Simple changes to the process of WOLS can improve conduct of end-of-life care in the ICU.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Analgesics / therapeutic use
  • Attitude of Health Personnel
  • Cardiopulmonary Resuscitation
  • Cause of Death
  • Diazepam / therapeutic use
  • Female
  • Humans
  • Hypnotics and Sedatives / therapeutic use
  • Intensive Care Units*
  • Life Support Care*
  • Male
  • Middle Aged
  • Nurses / psychology
  • Palliative Care*
  • Pastoral Care
  • Patient Admission
  • Physicians / psychology
  • Resuscitation Orders
  • Retrospective Studies
  • Withholding Treatment*

Substances

  • Analgesics
  • Hypnotics and Sedatives
  • Diazepam