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

BACKGROUND

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.

MEASURES: 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).

INTERVENTION: PDSA cycles include engagement of stakeholders to create the tools, BPG distribution, and presentations to intensive care units.

OUTCOMES: 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.

CONCLUSION/LESSONS LEARNED: Implementation of a BPG in pediatric WOLST procedure is feasible and helpful when used. Future work includes improved dissemination of the tool.