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A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation
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A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation

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Implantable cardioverter defibrillator deactivation: a hospice quality improvement initiative

Sally E Kraynik1, David J Casarett2, Amy M Corcoran2

  • 1University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA.

Journal of Pain and Symptom Management
|February 1, 2014
PubMed

Insights

Routine deactivation of implantable cardioverter defibrillators (ICDs) for dying patients is recommended. A quality improvement project successfully increased ICD deactivation rates in hospice patients through a multifaceted intervention.

Area of Science:

  • Cardiology
  • Palliative Care
  • Quality Improvement

Background:

  • Implantable cardioverter defibrillators (ICDs) can cause pain in dying patients when delivering shocks.
  • The National Quality Forum recommends routine ICD deactivation for end-of-life care.

Purpose of the Study:

  • To enhance the rate of ICD deactivation among patients in hospice care.
  • To evaluate the impact of a quality improvement initiative on ICD deactivation practices.

Main Methods:

  • A multifaceted intervention was implemented, including clinical tools, education, and standardized electronic medical record templates.
  • The study compared ICD deactivation rates before and after the intervention.

Main Results:

  • ICD deactivation rates significantly increased post-intervention (57% to 84%, P = 0.001).
  • Clinicians' knowledge and confidence in managing ICDs improved, with median questionnaire scores rising from 5 to 9 (P < 0.001).

Conclusions:

  • A comprehensive intervention effectively boosts ICD deactivation rates in patients nearing the end of life.
  • Improving clinician knowledge and confidence is key to successful end-of-life care for patients with ICDs.
Abstract

Keywords:
Implantable defibrillatorscardiac arrhythmiascardiovascular diseasedeactivationhospice careoutcome assessmentpalliative carepatient safetyquality improvementterminal care

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