|
|
| (127 intermediate revisions by 12 users not shown) |
| Line 1: |
Line 1: |
| DC (discontinuation) of treatment is the termination of life-supportive therapy 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]]. |
|
| |
|
| On the PDA, the'''DC Treat''' check box is on the Registry page.
| | {{Todo |
| | | 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. |
| | }} |
|
| |
|
| == When to code "DC Treat" == | | {{LegacyContent |
| * when the decision is made to discontinue treatment in ICU
| | |explanation=stopped collection in Medicine |
| * even if [[Palliative Care]] (90400) is provided and coded
| | |successor= various tmp and dx codes relating to [[palliative patient]]s and [[:category:End-of-life related data|End-of-life related data]] |
| As per the manual:
| | |content= |
| March 12.03 UPDATES
| |
|
| |
|
| RE: DC TREATMENT & TRANSFER/DISCHARGE READY DATES:
| | {{Data_element |
| | | 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 |
| | }} |
|
| |
|
| If the ICU physician DC’s TX (withdraws therapy) on a patient then TRANSFER/DISCHARGE READY DATE is NOT NEEDED.
| | 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. |
|
| |
|
| If a patient is on the transfer ready list and his condition deteriorates
| | Defined as terminal withdrawal with expectation of death of: |
| resulting in the need to remain in the unit, then this patient's transfer ready is CANCELLED. Please delete transfer ready date and time from your patient
| | * invasive mechanical ventilation (ET tube or trach) |
| Registry date or remember to change it if a patient is put back on the
| | * vasopressors or inotropes |
| transfer/discharge ready list.
| | * [[ECMO, VV]], [[ECMO, VA]] |
| | * VAD (Ventricular assistive device) |
|
| |
|
| If a patient arrests in your unit and CPR is unsuccessful—the date and time of stopping CPR should not be recorded for TRANSFER/DISCHARGE ready.
| | == See Also == |
| | See: [[Comfort Care]] |
|
| |
|
| If an unit physician discontinues TX and a patient is put on the transfer/discharge ready list but unexpectedly passes away prior to being to being moved out of your unit, then the recording of TRANSFER/DISCHARGE READY is appropriate.
| | == Log == |
| | * 2022-05-10 removed from collection screen |
|
| |
|
| === Discussion=== | | == Related articles == |
| * 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)
| | {{Related Articles}} |
| * 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 put on a bed transfer list, if the patient die before he is transferred out of the ICU
| |
|
| |
|
| == When not to code "DC Treat" ==
| |
| * "DC Treat" is not coded on Medicine wards
| |
| * This is not true at HSC. We are using the DC treatment code on the Medicine wards. [[User:GHall|GHall]] 19:14, 8 May 2008 (CDT)
| |
|
| |
|
| == Other Resources ==
| |
| *http://www.cja-jca.org/cgi/content/abstract/46/5/497 (GM Eschun, E Jacobsohn, D Roberts and B Sneiderman)
| |
| **you can see the FULL TEXT (PDF) if you select this option at the top right of the article on this page.
| |
|
| |
| *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.)
| |
|
| |
|
| |
| {{discussion}}
| |
| == Discussion ==
| |
| * 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)
| |
|
| |
| * Our current practice on Medicine at HSC is to use the DC treatment code when treatment is stopped and death is expected imminently.We have recently talked to Trish about how to code our comfort care patients and using the DC treatment box is often the case. If the patients death is not expected imminently we use the code for palliative care.It is confusing because the term palliative can mean many things. [[User:GHall|GHall]] 19:11, 8 May 2008 (CDT) **We are not coding DCtx at the Vic Medicine wards? Are we suppose to?Please let us know.[[User:SKiesman|SKiesman]] 14:51, 23 June 2008 (CDT)
| |
| **I believe that we should all be coding the same.I personally talked to Trish about the use of the DC treatment box for patients that death was expected imminently and she agreed that palliative would not be appropriate.So as far as I know you should use the DC treatment box.[[User:GHall|GHall]] 13:17, 4 July 2008 (CDT)
| |
|
| |
| * I removed the "ICU" from the instructions above. The first line used to say "in dying '''ICU''' patients. According to chats with Julie and I think Gail, it's not just ICU patients. [[User:Ttenbergen|Ttenbergen]] 23:30, 26 May 2008 (CDT)
| |
| {{Stub}}
| |
| [[Category:Data Collection Guide]] | | [[Category:Data Collection Guide]] |
| | [[Category:Registry Data]] |
| | [[Category:End-of-life related data]] |
| | }} |