Choi Daniel Y, Wagner Michael P, Yum Brian, Jannat-Khah Deanna Pereira, Mazique Derek C, Crossman Daniel J, Lee Jennifer I
Joan and Sanford I, Weill Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York City, New York, USA.
BMJ Open Qual. 2019 Dec 4;8(4):e000730. doi: 10.1136/bmjoq-2019-000730. eCollection 2019.
Unintended shocks from implantable cardioverter defibrillators (ICDs) are often distressing to patients and family members, particularly at the end of life. Unfortunately, a large proportion of ICDs remain active at the time of death among do not resuscitate (DNR) and comfort care patients.
We designed standardised teaching sessions for providers and implemented a novel decision tool in the electronic medical record (EMR) to improve the frequency of discussions surrounding ICD deactivation over a 6-month period. The intended population was patients on inpatient medicine and cardiology services made DNR and/or comfort care. These rates were compared with retrospective data from 6 months prior to our interventions.
After our interventions, the rates of discussions regarding deactivation of ICDs improved from 50% to 93% in comfort care patients and from 32% to 70% in DNR patients. The rates of deactivated ICDs improved from 45% to 73% in comfort care patients and from 29% to 40% in DNR patients.
Standardised education of healthcare providers and decision support tools and reminders in the EMR system are effective ways to increase awareness, discussion and deactivation of ICDs in comfort care and DNR patients.
植入式心脏复律除颤器（ICD）带来的意外电击常常令患者及其家属感到痛苦，尤其是在生命末期。不幸的是，在放弃心肺复苏（DNR）和接受舒适护理的患者中，很大一部分ICD在患者死亡时仍处于激活状态。
我们为医护人员设计了标准化教学课程，并在电子病历（EMR）中实施了一种新型决策工具，以在6个月的时间内提高围绕ICD停用进行讨论的频率。目标人群是接受住院内科和心脏病科服务且已做出DNR和/或舒适护理决定的患者。将这些比率与我们干预前6个月的回顾性数据进行比较。
在我们的干预措施实施后，接受舒适护理的患者中关于停用ICD的讨论比率从50%提高到了93%，DNR患者中这一比率从32%提高到了70%。接受舒适护理的患者中停用ICD的比率从45%提高到了73%，DNR患者中这一比率从29%提高到了40%。
对医疗保健提供者进行标准化教育以及在EMR系统中使用决策支持工具和提醒是提高对舒适护理和DNR患者中ICD的认识、讨论和停用率的有效方法。
