At OhioHealth, an electronic order set is used to facilitate withdrawal of life-sustaining treatment.
“We hoped to increase awareness of the order set and provide guidance for nonpalliative clinicians to feel comfortable to use it,” says Samantha Grable, Pharm D, a palliative care pharmacist at OhioHealth Grant Medical Center.
Grable and colleagues assessed the use of the order set and the time to inpatient death before and after the order set was updated.1
The updated order set contains the use of defaults (for example, pre-medication orders and nursing orders) to help provide the standard of care. It also implemented improved safety measures, including look-back to identify whether the patient has received neuromuscular blocking agents and guidance on medication choices based on patient renal function.
The researchers compared the time from activation of orders to patient death for 1,949 patients during a 12-month period before (2017-2018) and after (2021-2022) the order set was updated.
For patients who had palliative care consults, palliative clinicians were the users of the order set in 47% of cases. If orders were placed by a palliative clinician, median time to death was 4.5 hours, compared with 3.9 hours for nonpalliative specialists.
“It was encouraging to see that the majority of order set users were nonpalliative providers,” says Grable. Nurse practitioners were the most frequent users (39%) of the order set.
Overall, use of the tool increased 35.8% in the 2021-2022 group. “Our hope is that the withdrawal of life-sustaining treatment order set will be a practical tool to help navigate potentially highly emotional and stressful clinical situations,” concludes Grable.
REFERENCE
- Grable S, McKeon S, Burns B, et al. Observations from optimizing an electronic order set for withdrawal of life-sustaining treatment. J Palliat Med 2024; Feb 27. doi: 10.1089/jpm.2023.0380. [Online ahead of print].
At OhioHealth, an electronic order set is used to facilitate withdrawal of life-sustaining treatment.
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