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53 Please dont shock me: a qi project on implantable cardioverter defibrillators (icds) at the end of life care & dnar
  1. Mahvesh Javaid,
  2. Suzanne Squirrell,
  3. Fahad Farooqi
  1. Barking, Havering and Redbridge (BHR) NHS Trust


Introduction There is an increase in Implantable Cardioverter Defibrillators (ICDs) and Cardiac Resynchronization Therapy Defibrillators (CRT-Ds) being implanted every year. With patients living longer, the number of patients reaching the end of life with an active ICD or CRT-D is also on the rise. These can be missed or be mistaken for a pacemaker, especially during the end of life care.

Problem In 2015, at our hospital, 75% of patients with an ICD/CRT-D who died had no deactivation. Some of these patients did receive painful and undesirable shocks from their active ICD/CRT-D upon death; unfortunately witnessed by some of their worried families. The hospital staff were surveyed about the awareness on ICDs/CRT-Ds at the end of life and upon death, which revealed>60% of staff were unaware what to do.

Aims/Methodology A QI project was established to increase the number of ICD/CRT-D deactivation discussions and switch offs during the end of life care by 50%, over a 6 month period. Since January 2016, there were different interventions every month; including Grand round, departmental teaching, posters (Figure 1), implementing related questions in the palliative pathway and e-messages.

Results After 4 months, 66% of patients with an active ICD/CRT-D received discussions and switch-offs in advance with good timing before death (Figure 2). In turn, there was a strong impact on patient-centred care, quality and co-ordinated care, efficiency, effectiveness, cost and patient safety.

Conclusions ICDs/CRT-Ds can save lives. However, patients reaching the end of life should be put at ease and comfort by discussing ICD/CRT-D deactivation at DNAR (’Do Not Attempt Resuscitation’) discussion and have their ICD/CRT-D switched off in advance with good timing.

  • ICD
  • End of Life
  • Quality Improvement

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