Improving implantable cardioverter defibrillator deactivation discussions in admitted patients made DNR and comfort care

Figures

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  Figure 1. Run charts. Twenty-eight-week study period for (A) comfort care cohort and (B) DNR cohort showing the documented discussion rate (solid line) and the ICD deactivation rate (dotted line). Each data point reflects the percentage of successful outcomes divided by the total number of patients up to that week of data collection. The horizontal red dotted line is to compare with the rate of documented discussions or ICD deactivations in the retrospective data prior to any interventions. Study interventions are listed along the x-axis. DNR, do not resuscitate; EMR, electronic medical record; ICD, implantable cardioverter defibrillator; NP, nurse practitioner; PA, physician assistant.

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  Figure 2. Provider awareness of ICD status. Weekly survey targeting providers who entered DNR and/or comfort care orders. Ten DNR patients and five comfort care patients were selected at random using a number generator. (A) The comfort care order set was added on week 14. Providers who answered ‘Y’ were 49% (24/49) pre-EMR vs 95% (36/38) post-EMR change (p<0.01). (B) The DNR document pop-up was added on week 18. Providers who answered Y were 48% (63/131) pre-EMR vs 93% (40/43) post-EMR change (p<0.01). DNR, do not resuscitate; EMR, electronic medical record; ICD, implantable cardioverter defibrillator; N, no; Y, yes.