DC Treatment

Discontinuation of treatment (DC TX) is the termination of life-support treatment in an intensive care setting.

• 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.

DC TX checkbox location on PDA or ACCESS

• On the PDA the DC Treatment is a yes/no check-box. It can be found on the "Reg" page.
• In ACCESS (CCMDB.mdb) the checkbox is on the "Reg, ADL and Variables" tab.

When to document "DC TX"

• when the decision has been made to terminate life-support treatment.

DC TX & Transfer Ready Date/time

• If the unit physician discontinues life-support treatment (withdraws therapy) on a patient then Transfer ready should be left blank. This field is not for recording the date and time when discontinuation of life support process started.

• If an unit physician discontinues life-support treatment and a patient does not die immediately and is place on a transfer/ready list, and then passes away prior to being transferred out of the ICU unit, then Transfer ready should not be recorded.

• If a patient arrests in the unit and CPR is unsuccessful, the date and time of stopping CPR should not be recorded for Transfer ready.

Discussion

• 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.FLindell 13:34, 2 June 2008 (CDT)
• 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.
  • <who wrote this?>The Christmas Elf.
    • Shouldn't the transfer-ready instructions should reside with that article, not here? Ttenbergen 12:03, 27 November 2008 (CST)
      • FRAN.........????

When not to code "DC Treat"

• "DC Treat" is not coded on Medicine wards
• who put this in here?

Discussion

• This is not true at HSC. We are using the DC treatment code on the Medicine wards. 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)1999.
  • 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.)

Template:Discussion

Discussion

Palliative care and Survival of DC Treat patients

• 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)
  • 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? Ttenbergen 12:08, 27 November 2008 (CST)
• (...) 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 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.GHall 13:17, 4 July 2008 (CDT)

DC Treat usage in Medicine

• Our current practice on Medicine at HSC is to use the DC treatment code when treatment is stopped and death is expected imminently. (...) GHall 19:11, 8 May 2008 (CDT)
  • We are not coding DC tx at the Vic Medicine wards? Are we suppose to? Please let us know.SKiesman 14:51, 23 June 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)
  • I added critical care back in... Ttenbergen 11:58, 27 November 2008 (CST)

Nov 27.08

• • • the course of events is not always predictable after the withdrawl 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.
    • 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.
    • If death is not immediate after the stopping of life support(DC TX), then use code palliative
    • 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.

TOstryzniuk 01:32, 28 November 2008 (CST) Template:Stub [[Agree with above statement. This is the way I have been coding D/C treatment}}--FLindell 08:39, 4 December 2008 (CST)

• • • • 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? WGobert 09:38, 4 December 2008 (CST)