Implementing a Best Practice Guideline for Withdrawing Life Sustaining Therapies at a Large Pediatric Hospital

Area of Science:

• Pediatric critical care medicine
• Clinical practice guideline development
• End-of-life care research

Background:

• Withdrawal of Life Sustaining Therapies (WOLST) is a critical procedure in pediatric inpatient deaths.
• No established best practice guideline (BPG) currently exists for pediatric WOLST.
• This study aimed to develop and implement a BPG and standard note template for WOLST.

Purpose of the Study:

• To develop and implement a best practice guideline (BPG) for pediatric Withdrawal of Life Sustaining Therapies (WOLST).
• To create and implement a standard note template to support WOLST procedures.
• To evaluate the feasibility and helpfulness of the developed BPG and template.

Main Methods:

• Utilized Plan-Do-Study-Act (PDSA) cycles for tool development and implementation.
• Engaged stakeholders, distributed the BPG, and conducted presentations in intensive care units.
• Measured tool usage (process), perceived usefulness (outcome), and unintended consequences.

Main Results:

• 100% of users found the note template helpful; 95% found the BPG helpful.
• Despite helpfulness, 65% were unaware of the note template and 78% unaware of the BPG.
• The study aimed for a 20% increase in tool use within 6 months.

Conclusions:

• Implementation of a BPG for pediatric WOLST is feasible and beneficial.
• The developed tools (BPG and note template) are perceived as helpful by users.
• Improved dissemination strategies are necessary for broader adoption and impact.