Implantable cardioverter defibrillator deactivation: a hospice quality improvement initiative

Background: Dying patients whose implantable cardioverter defibrillators (ICDs) continue to deliver shocks may experience significant pain, and the National Quality Forum has endorsed routine deactivation of ICDs when patients near the end of life. The overarching goal of this quality improvement project was to increase rates of ICD deactivation among hospice patients.

Measures: ICD deactivation rates pre- vs. post-intervention; and clinicians' knowledge and confidence regarding ICD management.

Intervention: A multifaceted intervention included clinical tools, education, and standardized documentation templates in the electronic medical record.

Outcomes: The proportion of patients whose ICD was deactivated increased after the intervention (pre- vs. post-intervention: 39/68, 57% vs. 47/56, 84%; odds ratio 3.88; 95% confidence interval 1.54-10.37; P = 0.001). Clinicians' knowledge and confidence regarding ICD management improved (pre- vs. post-intervention median questionnaire scores: 5 vs. 9 on a scale of 0 to 10; Wilcoxon signed-rank test Z = -5.01; P < 0.001).

Conclusions/lessons learned: A multifaceted intervention can increase rates of ICD deactivation among patients near the end of life.