Implementing a Best Practice Guideline for Withdrawing Life Sustaining Therapies at a Large Pediatric Hospital.

Abstract

Withdrawal of Life Sustaining Therapies (WOLST) is a critical procedure in up to 50% of inpatient pediatric deaths. No best practice guideline (BPG) exists. We aimed to develop and implement a BPG and standard note template for WOLST procedures. The smart aim was to increase use of the tools by 20% within 6 months. The measures were the percentage of tools used (process), usefulness of the tool (outcome), and narrative responses to identify unintended consequences (balance). PDSA cycles include engagement of stakeholders to create the tools, BPG distribution, and presentations to intensive care units. Of those who used the tools, 100% found the note helpful and 95% found the BPG helpful. 65% and 78% of respondents reported not knowing about the note template or BPG, respectively. Implementation of a BPG in pediatric WOLST procedure is feasible and helpful when used. Future work includes improved dissemination of the tool.