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Canadian Journal of Anesthesia

, Volume 51, Issue 6, pp 631–636 | Cite as

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

  • Richard I. Hall
  • Graeme M. RockerEmail author
  • Dawnelda Murray
Neuroanesthesia and Intensive Care

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 POSTP = 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.

Keywords

Life Support Pastoral Care Post Period Teaching Hospital Tertiary Care Practice Review 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Des changements simples peuvent améliorer les soins aux mourants à l’unité des soins intensifs

Résumé

Objectif

Décrire les changements apportés au retrait du maintien des fonctions vitales (RMFV) dans deux unités de soins intensifs (USI) médicaux et chirurgicaux d’un centre hospitalier universitaire de soins tertiaires au cours de deux périodes distinctes.

Méthode

Nous avons utilisé une revue rétrospective des dossiers et réalisé une comparaison du type avant-après. Nous avons évalué les différents aspects des soins aux mourants de l’USI, décédés après le RMFV, avant et après l’introduction d’instruments clarifant l’ordonnance de ne pas réanimer (PDR) et normalisant le processus de RMFV. Nous avons recueilli les suggestions de la famille sur les soins aux mourants et modifié les ordonnances des médecins sur l’analgésie et la sédation.

Résultats

Cent trente-huit patients sont décédés après le RMFV dans les USI entre juillet 1996 et juin 1997 (PRE) et 168 après un RMFV entre mai 1998 et avril 1999 (POST). L’ntervalle entre l’admission à l’USI et le RMFV (moyenne ± écart type) a été plus court dans la période POST (191 ± 260 h PRE vs 135 ± 205 h POST, P = 0,05). Moins de patients du groupe POST ont reçu une réanimation cardiopulmonaire dans les 12 h précédant la mort (PRE = 7; POST = 0: P < 0,05). Moins de médicaments de confort ont été utilisés (PRE: 1,7 ± 1,0 vs POST: 1,4 ± 1,0; P < 0,05). La dose cumulative moyenne de diazépam (PRE: 20,0 vs POST: 10,0 mg; P < 0,05) a diminué. La participation des médecins aux discussions sur le RMFV n’a pas changé mais les interventions du service de pastorale ont augmenté (PRE: 10/138 vs POST: 120/168 cas; P < 0,05). La majorité des infirmières (80 %) croyaient que les ordonnances modifiées de PDR et de RMFV ont permis d’améliorer le traitement entourant le RMFV.

Conclusion

Des changements simples au processus de RMFV peuvent améliorer les soins aux mourants dans une USI.

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Copyright information

© Canadian Anesthesiologists 2004

Authors and Affiliations

  • Richard I. Hall
    • 1
  • Graeme M. Rocker
    • 2
    Email author
  • Dawnelda Murray
    • 3
  1. 1.Department of AnesthesiaDalhousie UniversityCanada
  2. 2.Department of MedicineDalhousie UniversityCanada
  3. 3.Critical Care ProgramQueen Elizabeth II Health Sciences CentreHalifaxCanada

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