TY - JOUR
T1 - Implantable cardioverter defibrillator deactivation
T2 - A hospice quality improvement initiative
AU - Kraynik, Sally E.
AU - Casarett, David J.
AU - Corcoran, Amy M.
N1 - Funding Information:
Dr. Corcoran is supported by a Health Resources and Services Administration (HRSA) Geriatric Academic Career Award K01HP20493 . The information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by the Department of Health and Human Services, HRSA, Bureau of Health Professions or the U.S. Government.
Publisher Copyright:
© 2014 American Academy of Hospice and Palliative Medicine.
PY - 2014/9/1
Y1 - 2014/9/1
N2 - Background. Dying patients whose implantable cardioverter defibrillators (ICDs) continue to deliver shocks may experience significant pain, and the National Quality Forum has endorsed routine deactivation of ICDs when patients near the end of life. The overarching goal of this quality improvement project was to increase rates of ICD deactivation among hospice patients. Measures. ICD deactivation rates pre- vs. post-intervention; and clinicians' knowledge and confidence regarding ICD management. Intervention. A multifaceted intervention included clinical tools, education, and standardized documentation templates in the electronic medical record. Outcomes. The proportion of patients whose ICD was deactivated increased after the intervention (pre- vs. post-intervention: 39/68, 57% vs. 47/56, 84%; odds ratio 3.88; 95% confidence interval 1.54-10.37; P = 0.001). Clinicians' knowledge and confidence regarding ICD management improved (pre- vs. post-intervention median questionnaire scores: 5 vs. 9 on a scale of 0 to 10; Wilcoxon signed-rank test Z = -5.01; P < 0.001). Conclusions/Lessons Learned. A multifaceted intervention can increase rates of ICD deactivation among patients near the end of life.
AB - Background. Dying patients whose implantable cardioverter defibrillators (ICDs) continue to deliver shocks may experience significant pain, and the National Quality Forum has endorsed routine deactivation of ICDs when patients near the end of life. The overarching goal of this quality improvement project was to increase rates of ICD deactivation among hospice patients. Measures. ICD deactivation rates pre- vs. post-intervention; and clinicians' knowledge and confidence regarding ICD management. Intervention. A multifaceted intervention included clinical tools, education, and standardized documentation templates in the electronic medical record. Outcomes. The proportion of patients whose ICD was deactivated increased after the intervention (pre- vs. post-intervention: 39/68, 57% vs. 47/56, 84%; odds ratio 3.88; 95% confidence interval 1.54-10.37; P = 0.001). Clinicians' knowledge and confidence regarding ICD management improved (pre- vs. post-intervention median questionnaire scores: 5 vs. 9 on a scale of 0 to 10; Wilcoxon signed-rank test Z = -5.01; P < 0.001). Conclusions/Lessons Learned. A multifaceted intervention can increase rates of ICD deactivation among patients near the end of life.
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U2 - 10.1016/j.jpainsymman.2013.09.010
DO - 10.1016/j.jpainsymman.2013.09.010
M3 - Article
C2 - 24480530
AN - SCOPUS:84923491710
SN - 0885-3924
VL - 48
SP - 471
EP - 477
JO - Journal of Pain and Symptom Management
JF - Journal of Pain and Symptom Management
IS - 3
ER -