DC Treatment

The DC Treat check box on the Registry page of the PDA tracks the withdrawal of treatment in dying patients when appropriate.

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.)

When to code "DC Treat"

• when the decision is made to discontinue treatment in ICU
• even if Palliative Care (90400) is provided and coded

As per the manual: March 12.03 UPDATES RE: DC TREATMENT & TRANSFER/DISCHARGE READY DATES:

   If you ICU physician DC’s TX (withdraws therapy) on a patient then TRANSFER/DISCHARGE READY DATE is NOT NEEDED. 	

If a patient is on the transfer ready list and his condition deteriorates resulting in the need to remain in the unit, then this patients transfer ready is CANCELLED. Please delete transfer ready date and time from your patient Registry date or remember to change it if a patient is put back on the transfer/discharge ready list.

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.

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.

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. GHall 19:14, 8 May 2008 (CDT)

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. --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. GHall 19:11, 8 May 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. Ttenbergen 23:30, 26 May 2008 (CDT)