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 in CCMDB.mdb

• 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 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 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)
  • If the patient does not die Fran has a point. We should review. Ttenbergen 11:46, 5 December 2008 (CST)
  • 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. The Christmas Elf 02:40, 28 November 2008
    • Why is it the Transfer date and time not relevant if the patient dies before they transfer actually happens?Ttenbergen 11:52, 5 December 2008 (CST)

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.)

DC Treatment vs. Palliative Care

to be filled in with summary of stuff pertaining to both Template:Discussion

Discussion

DC Treat usage in Medicine

• 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 caremedications are given.Often these medications include narcotics,antiemetics and scopalomine.
• 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)

Palliative care and Survival of DC Treat patients

• For 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 DC treatment.
• Use palliative if the patient's death is not expected to occur imminently.
• 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)