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| Discontinuation of treatment (DC TX) is the termination of life-support treatment in an intensive care setting.
| | The concept encoded by this is slightly different than other [[:Category:End-of-life related data|End-of-life related data]] so it can not be transferred into new fields that encode related concepts, so we will keep it in the [[Centralized_data.accdb]]'s [[L Log table]]. It has been removed from [[CCMDB.accdb]]. |
| *Life support treatment may include, but is not limited to, mechanical ventilation, dialysis, medications (including vasoactive drugs and antibiotics), chemotherapy, artifical nutrition/hydration and supplementary oxygen.
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| ==DC TX checkbox location in CCMDB.mdb== | | {{Todo |
| *In '''ACCESS''' ([[CCMDB.mdb]]) the checkbox is on the "''Reg, ADL and Variables''" tab. | | | who = Tina |
| | | todo_added = 2022-06-30 |
| | | todo_action = 2023-05-04 |
| | | question = _dev_CFE_Data |
| | * The field has a length of 50 and should be reduced to 2 now that that's the longest content. |
| | }} |
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| === When to document "DC TX" === | | {{LegacyContent |
| * when the decision has been made to terminate life-support treatment.
| | |explanation=stopped collection in Medicine |
| | |successor= various tmp and dx codes relating to [[palliative patient]]s and [[:category:End-of-life related data|End-of-life related data]] |
| | |content= |
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| === DC TX & Transfer Ready Date/time === | | {{Data_element |
| *If the unit physician discontinues life-support treatment (withdraws therapy) on a patient then '''[[Admit, Transfer and Discharge date and time#Transfer_Date_and_Time|Transfer ready]]''' '''should be left blank'''. This field is not for recording the date and time when discontinuation of life support process started.
| | | field_name = R_dc_treat |
| | | element_description = "DC" for critical care patients if life-support treatment is terminated, blank for all others. |
| | | in_table = L_Log table |
| | | data_type = string |
| | | datafield_length=50 |
| | | program_collecting = CC |
| | | created_raw = Raw |
| | | data_element_sort_index = 12 |
| | | data_element_end_date = 2022-05-10 |
| | }} |
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| *If a unit physician discontinues life-support treatment and a patient does not die immediately and is placed on a transfer/ready list, and then passes away prior to being transferred out of the ICU unit, then [[Admit, Transfer and Discharge date and time#Transfer_Date_and_Time|Transfer ready]] should not be recorded.
| | This field was also collected in Medicine until 2013-07-04. Collection stopped because the distinction is not clear enough for coding on a medicine ward. |
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| *If a patient '''arrests''' in the unit and CPR is unsuccessful, the date and time of stopping CPR should '''not''' be recorded for [[Admit, Transfer and Discharge date and time#Transfer_Date_and_Time|Transfer ready]]. | | Defined as terminal withdrawal with expectation of death of: |
| | * invasive mechanical ventilation (ET tube or trach) |
| | * vasopressors or inotropes |
| | * [[ECMO, VV]], [[ECMO, VA]] |
| | * VAD (Ventricular assistive device) |
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| ==== Discussion ==== | | == See Also == |
| * Disagree with NOT NEEDING a transfer ready time. This time is needed to account for delays in transfer and availability of beds on the wards.[[User:FLindell|FLindell]] 13:34, 2 June 2008 (CDT)
| | See: [[Comfort Care]] |
| ** If the patient does '''not''' die Fran has a point. We should review. [[User:Ttenbergen|Ttenbergen]] 11:46, 5 December 2008 (CST)
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| ** I am not sure if you are referring to the last point above or not. If TX is DC'd and death is not immediate, which is sometimes the case, and a patient is put on a bed transfer list, if the patient dies before he is transferred out of the ICU the issue of transfer delay for this patient is no longer relevant. [[User:TOstryzniuk|The Christmas Elf]] 02:40, 28 November 2008
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| *** Why is it the Transfer date and time not relevant if the patient dies before they transfer actually happens?[[User:Ttenbergen|Ttenbergen]] 11:52, 5 December 2008 (CST)
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| == When not to code "DC Treat" == | | == Log == |
| | * 2022-05-10 removed from collection screen |
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| == Other Resources == | | == Related articles == |
| *http://www.cja-jca.org/cgi/content/abstract/46/5/497 (GM Eschun, E Jacobsohn, D Roberts and B Sneiderman)1999.
| | {{Related Articles}} |
| **you can see the FULL TEXT (PDF) if you select this option at the top right of the article on this page.
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| *Withdrawal of treatment is not the same as withdrawal of care. DC Treatment in an ICU setting occurs because it is often possible to maintain life for long periods of time without any hope of recovery. Intensive care is a means of supporting organ systems and it is not always curative. Prolonging the process of dying is not in the patient's best interests nor is it ethical. (Winter,B. & Cohen,S. (1999). ABC of intensive care. Withdrawal of treatment. ''BMJ 319'', 306-308.)
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| == DC Treatment vs. Palliative Care ==
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| to be filled in with summary of stuff pertaining to both
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| {{discussion}}
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| == Discussion ==
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| === DC Treat usage in Medicine ===
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| * Our current practice on Medicine at HSC is to use the DC treatment code when active treatment is discontinued and death is expected imminently.In doctors orders VS are stopped,blood work is stopped,usually all meds except''' comfort care'''medications are given.Often these medications include narcotics,antiemetics and scopalomine.
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| *We are not coding DC tx at the Vic Medicine wards? Are we suppose to? Please let us know.[[User:SKiesman|SKiesman]] 14:51, 23 June 2008 (CDT)
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| === Palliative care and Survival of DC Treat patients ===
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| *I have talked again with Trish about Medicine patients who have treatment discontinued and comfort measures provided. It is not necessary to double code patients with DC treatment and palliative if death is imminent.Use palliative if the patient's death is not expected to occur imminently.
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| ** Is there an expectation to see DC patients survive their ICU stay? How sure of an expectation? Can this still be checked if the patient survives? Usually DC treatment involves removing life support devices which subsequently results in death. However, occasionally the patient may survive to go to a Palliative care ward and in this event [[Palliative care]] should also be coded. --[[User:LKolesar|LKolesar]] 12:54, 8 May 2008 (CDT)
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| ** I believe this is now addressed above by stating that DC Treat can be coded together with Palliative. If that clarifies, Laura can you delete this section? If it is still not clear, can you explain what is the remaining question? [[User:Ttenbergen|Ttenbergen]] 12:08, 27 November 2008 (CST)
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| ***the course of events is not always predictable after the withdrawal of life support treatment. Some patients may die immediately after cessation of ventilator or vassopressor support, while others may survive for hours or even days. who? [[User:TOstryzniuk|TOstryzniuk]] 01:32, 28 November 2008 (CST)
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| ***any patient who has life support treatment withdrawn (DC TX) is also palliative throughout this process. Therefore if death is immediate after stopping life support then there is no need to code palliative.who? [[User:TOstryzniuk|TOstryzniuk]] 01:32, 28 November 2008 (CST)
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| ***If death is not immediate after the stopping of life support(DC TX), then use code palliative who? [[User:TOstryzniuk|TOstryzniuk]] 01:32, 28 November 2008 (CST)
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| ***if a patient who life support treatment was DC'd and he did not die in the ICU and was transferred to a ward and died there a few hours or days later, the ward primary admission code would be Palliative Care, and the DC TX box must also be checked off. [[User:TOstryzniuk|TOstryzniuk]] 01:32, 28 November 2008 (CST)
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| **Agree with above statement. This is the way I have been coding D/C treatment}}--[[User:FLindell|FLindell]] 08:39, 4 December 2008 (CST)
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| ***Here at the Vic, when we have a patient deemed ACP 1, we do not use D/C treatment. If a patient comes up from ICU and they are D/C treatment there, we do code them as palliative care, I personally have not been using the D/C treatment. So this is a collection difference. What is considered imminent? When you say death is imminent? Do we continue to code this way, or are we now going to change the way this info is coded this far into the project? [[User:WGobert|WGobert]] 09:38, 4 December 2008 (CST
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| {{Stub}}
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| [[Category:Data Collection Guide]] | | [[Category:Data Collection Guide]] |
| [[Category: Registry Data]] | | [[Category:Registry Data]] |
| [[Category:Questions General Collection]] | | [[Category:End-of-life related data]] |
| | }} |
