Background A growing number of patients have ICDs and CRT-Ds in situ (Bradshaw, Stobie, Briffa et al, 2013. Am Heart J. 165: 816). Although all device follow up centres (including those which only follow up pacemakers) should have provision for deactivation of ICD function including the facility for domiciliary visits (Beattie. ICD deactivation at the end life: principles and practice. 2009), in our experience, this is rarely available the same day or out of hours.
Unfortunately, ICDs are not always deactivated in a timely way before patients enter the terminal phase (Hill, McIlfatrick, Taylor, et al., 2015. Eur J Cardiovasc Nurs. 15: 20), with the risk of delivering unpleasant and unnecessary shocks during the dying process estimated at occurring in up to 33% patients with an ICD who die non-suddenly (Stoevelaar, Brinkman-Stoppelenburg, Bhagwandien, et al., 2018. Eur J Cardiovasc Nurs. 17: 477).
The need for urgent ICD deactivation was a recent issue with two hospice patients who deteriorated rapidly before deactivation had been performed. Given this risk, a process to support hospice staff in accessing urgent guidance and appropriate magnets is needed.
Aim To create a clear process for staff to follow when ICDs need deactivating which increases knowledge and confidence in clinical staff, using a plan-do-study-act (PDSA) quality improvement approach.
Method We are liaising with cardiology departments in hospitals serving our patient population to create a process which allows signposting to relevant teams to access urgent specialist expertise. This will include process to follow in-hours, out of hours, the use of magnets, and after death processes. An assessment of hospice clinicians’ knowledge and confidence will be carried out prior to disseminating the guidance and after it has been shared to ensure the aim of improving these has been successful, and to guide further improvements.
Results We hope that we will be able to demonstrate a clear process with an improvement in knowledge and confidence.
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