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 and death is immediate, 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.

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 bothTemplate: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.
• I think it is more accurate to describe medical ward DC tx as palliative care as it indicates the shift in focus better than D/C treatment. I think D/C treatment should only apply to withdrawal of life support devices in the ICU for the purposes of the database. I will clarify this in the task group. --LKolesar 07:09, 13 December 2011 (CST)
  • DC treatment on Medicine is as stated above. Palliative Care refers to those patients ACCEPTED by the Palliative Care Program-- it is not used as a treatment modality and death is NOT imminent.--CMarks 13:59, 14 December 2011 (CST)
    • above as in what Laura said or as in what the article originally said? Ttenbergen 14:43, 14 December 2011 (CST)Template:Discussion
      • As above in the statement in this area that begins with "Our current practice on Medicine at HSC..."--CMarks 11:46, 15 December 2011 (CST)
        • We have discussed this with Trish many years ago and we at HSC use D/C of treatment on the wards if death is

Imminent ( eg. if a CVA comes into the ER and is expected to pass we will put CVA and D/C treatment death is usually within days (palliative care death is not imminent is usually chronic diseases eg cancers)--PStein 14:07, 19 December 2011 (CST)

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)

Transfer ready date for DC Treatment/Palliative patients

Template:Discussion Pts who become ACPC and expire in hospital 3 days to one month after comfort care is ordered.

• I would like to know where this type of patients fits in. Example: a patient who has co- morbids and is admitted with pneumonia and does not improve or deteriorates. The decision is made to provide comfort care only (ACPC). This patient lives three days to one month in hospital and then dies. Does this patient need a transfer ready date?
  • I currently code pts who become ACPC and then die within 48 hours as D/C treatment and do not fill out the transfer ready space. If the patient lives longer than 48 hours I will code the patient as Palliative Care and fill the transfer ready space when the order of ACPC is written. Many of my admitted pts come to the hospital to die and I'm not sure if these patients fit into the transfer/overstay predictor project. Please let me know how you code these cases.Judy Kublick 11:32, 2012 September 24 (CDT)~~