000			02744cam a2200181 4500
001			NMDX7488
008			120401t2016 xxu||||| |||| 00| 0 eng d
100			_aTharmalingam, B.
240			_aIntensive Care Medicine Experimental
245			_aThis is how we do it, an audit on end of life care decision in critical care unit NMUH
260			_c2016
500			_aNMUH Staff Publications
500			_aEMBASE
500			_a4
520			_a<span style="font-size: 10pt;">Majority of death occur in critical care unit (CCU) after withdrawal/withholding of treatment. Our aim was to analyse the documentation of the complex issues surrounding end of life care (EOL) decision in our CCU. We collected data about our CCU practice of EOL decision and compared with the best practice recommended by Royal college of Anaesthetist in 2012. Our goal was to improve the quality of care of the patients with EOL in our CCU. It's a retrospective audit. All the patients in CCU for whom the decision of withdrawal of life prolonging treatment from 01/04/2014-31/03/2015 were included in this study. The data was taken from ACUBASE electronic notes and CCU monitoring charts of the relevant cases and analysed using Microsoft EXCEL. Out of the 217 deaths in CCU 81 (37.3 %) were due to withdrawal of treatment. We had found the excellent documentation regarding family discussion (93.8 %) and formal decision of withdrawal of support (83.9 %). All the patients (100 %) had valid DNACPR form. The documentation of method of withdrawal was 59.2 %, on the other hand the treatment limitation on admission as advanced care plan, documentation of patient discussion about EOL, consideration of spiritual aspect, time of withdrawal, organ donation were documented in 22 %,2 %,12 %,16 % and 30 % of cases respectively. In the method of withdrawal we audited the organ supports and symptom relief medications. Only 73 % of the patients had analgesics and 26 % had sedatives during the process of dying. This is because the prescription was done in drug chart. Feeds/fluids were continued in 78 % of patients. As a result of this audit we proposed the following actions To formulate a template in ACUBASE with essential elements of EOL which will be filled by the relevant CCU consultant and copy of it will be handed over to the bed side nurse for further care. The time of withdrawal will be documented by the bed side nurse after family gathering and fulfilment of spiritual aspects in the monitoring chart and the doctor who certifies the death will document it on the ACUBASE. </span>
700			_aKovari, F.
856			_uhttps://icm-experimental.springeropen.com/track/pdf/10.1186/s40635-016-0099-9?site=icm-experimental.springeropen.com
999			_c76368 _d76368