DC Treatment: Difference between revisions

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Discontinuation of treatment (DC TX) is the termination of life-support treatment in an intensive care setting.
The DC Treatment field (discontinuation of treatment or DC TX) should be coded in the Critical Care program only if life-support treatment is terminated. The field is on the "''Reg & ADL & Var''" tab on the [[Patient Viewer]] in [[CCMDB.mdb]].
*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 ===
=== DC TX & Transfer Ready Date/time ===
*If the unit physician discontinues life-support treatment (withdraws therapy) on a patient and death is immediate, then '''[[Admit, Transfer and Discharge date and time#Transfer_Date_and_Time|Transfer ready]]''' '''should be left blank'''. This field is not for recording the date and time when discontinuation of life support process started.
*If the unit physician discontinues life-support treatment (withdraws therapy) on a patient and death is immediate, then '''[[Admit, Transfer and Discharge date and time#Transfer_Date_and_Time|Transfer ready]]''' '''should be left blank'''. This field is not for recording the date and time when discontinuation of life support process started.
** is this true even if the transfer ready date was entered much sooner, e.g. a patient was transfer ready and deteriorated several days later? Isn't what we really want just to say the second part: do not use the transfer ready date to indicate dc tx time? Ttenbergen 09:47, 2013 July 4 (CDT) {{discussion}}


*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 [[Admit, Transfer and Discharge date and time#Transfer_Date_and_Time|Transfer ready]] should '''not''' be recorded.
*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 [[Admit, Transfer and Discharge date and time#Transfer_Date_and_Time|Transfer ready]] should '''not''' be recorded.
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*If a patient '''arrests''' in the unit and CPR is unsuccessful, the date and time of stopping CPR should '''not''' be recorded for [[Admit, Transfer and Discharge date and time#Transfer_Date_and_Time|Transfer ready]].
*If a patient '''arrests''' in the unit and CPR is unsuccessful, the date and time of stopping CPR should '''not''' be recorded for [[Admit, Transfer and Discharge date and time#Transfer_Date_and_Time|Transfer ready]].


 
{{discussion}} Pts who become ACPC and expire in hospital 3 days to one month after comfort care is ordered.
== When not to code "DC Treat" ==
* 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)~~


== Other Resources ==
== Other Resources ==
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**you can see the FULL TEXT (PDF) if you select this option at the top right of the article on this page.
**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.)
== Legacy Information ==
 
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.
== DC Treatment vs. [[Palliative Care]] ==
to be filled in with summary of stuff pertaining to both{{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 care'''medications 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.  --[[User:LKolesar|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.--[[User:CMarks|CMarks]] 13:59, 14 December 2011 (CST)
*** above as in what Laura said or as in what the article originally said? [[User:Ttenbergen|Ttenbergen]] 14:43, 14 December 2011 (CST){{discussion}}
****As above in the statement in this area that begins with "Our current practice on Medicine at HSC..."--[[User:CMarks|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)--[[User:PStein|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. [[User:TOstryzniuk|TOstryzniuk]] 01:32, 28 November 2008 (CST)
 
===Transfer ready date for DC Treatment/Palliative patients===
{{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)~~
 




[[Category:Data Collection Guide]]
[[Category:Data Collection Guide]]
[[Category: Registry Data]]
[[Category: Registry Data]]
[[Category:Questions General Collection]]
[[Category:DC TX]]
[[Category:DC TX]]

Revision as of 09:47, 2013 July 4

The DC Treatment field (discontinuation of treatment or DC TX) should be coded in the Critical Care program only if life-support treatment is terminated. The field is on the "Reg & ADL & Var" tab on the Patient Viewer in CCMDB.mdb.

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.
    • is this true even if the transfer ready date was entered much sooner, e.g. a patient was transfer ready and deteriorated several days later? Isn't what we really want just to say the second part: do not use the transfer ready date to indicate dc tx time? Ttenbergen 09:47, 2013 July 4 (CDT) Template:Discussion
  • 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.

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)~~

Other Resources

Legacy Information

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.

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