Documentation on withdrawal of life support in adult patients in the intensive care unit.
BACKGROUND
Patients' charts have been a source of data for retrospective studies of the quality of end-of-life care. In the intensive care unit, most patients die after withdrawal of life support. Chart reviews of this process could be used not only to assess the quality of documentation but also to provide information for quality improvement and research.


OBJECTIVE
To assess the documentation of end-of-life care of patients and their families by care providers in the intensive care unit.


METHODS
Charts of 50 adult patients who died in the intensive care unit at a large midwestern hospital after initiation of withdrawal of life support (primarily mechanical ventilation) were reviewed. A form developed for the study was used for data collection.


RESULTS
The initiation of the decision making for withdrawal was documented in all 50 charts. Sixteen charts (32%) had no information on advance directives. Eight charts (16%) had no documentation on resuscitation status. About two thirds of the charts documented nurses' participation during the withdrawal process; only one tenth documented physicians' participation. A total of 13 charts (26%) had no information on the time of initiation of the withdrawal process, and 11 (22%) had no documentation of medications administered for withdrawal. Thirty-seven charts (74%) had information on whether the patient was or was not extubated during withdrawal.


CONCLUSIONS
Comprehensive documentation of end-of-life care is lacking.
University of Wisconsin, School of Nursing, Madison, Wis, USA.
Karin T
KT
Kirchhoff
Prashanth Reddy
PR
Anumandla
Kristine Therese
KT
Foth
Shea Nicole
SN
Lues
Stephanie Ho
SH
Gilbertson-White
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making / Q000502:physiology; D004282:Documentation / Q000592:standards*; D005260:Female; D005568:Forms and Records Control; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D008020:Life Support Care / Q000592:standards*; D008297:Male; D008499:Medical Records / Q000592:standards*; D008875:Middle Aged; D015146:Midwestern United States; D011368:Professional-Family Relations; D016414:Resuscitation Orders; D013727:Terminal Care / Q000379:methods; D028761:Withholding Treatment / Q000592:standards*