Portal de Periódicos da CAPES

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

2004; Springer Science+Business Media; Volume: 51; Issue: 6 Linguagem: Inglês

10.1007/bf03018408

1496-8975

Richard Hall, Graeme Rocker, Dawnelda Murray,

Healthcare Decision-Making and Restraints

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