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Policy should outline steps for deactivation
Clinical team, resource nurses provide extra support
The policy for deactivation of an implantable cardioverter-defibrillator (ICD) at Hospice of the Western Reserve in Cleveland, OH, clearly spells out the steps and responsibilities of deactivating an ICD's shocking program.
Staff members also receive training and continuous support from other hospice staff when a patient has an ICD and must be presented with the option of deactivation.
"Complex cases, such as patients with ICDs, are discussed in team meetings," says Trudi Kozak, RN, CHPN, clinical team leader at the hospice. "We review our practice related to ICDs, review patients' medical directives, and discuss the benefits and burdens of ICDs for a hospice patient."
When holding the conversation with patients and their families, assess how much the patient understands, Kozak says. "I've been surprised at how much families understand," she adds. "The technologists who contact the families on a regular basis to monitor the device do a good job educating them."
Once a patient decides to deactivate the device, nurses contact the patient's physician to obtain an order for deactivation. "I've never had an internist or cardiologist question the decision to deactivate," says Kozak. During the nurse's conversation with the physician, the best location for deactivation is determined. If the patient is unable to go to a physician's office or clinic, the deactivation occurs at the home, Kozak says.
If it is not an emergency situation in which the device has begun to shock the patient repeatedly, the manufacturer's representative is asked to come to the home, she says. If there is no time for the representative's visit, the nurse uses a magnet to deactivate the device, Kozak says.
"A common misunderstanding is that the magnet can be placed on the patient for a short period of time," she says. The reality is that the device is only deactivated when the magnet is in place, Kozak says. "The magnet must be taped directly over the device and left in place," she says.
A resource nurse accompanies the patient's primary nurse to the home to place the magnet, says Kozak. "The joint visit gives the primary nurse an opportunity to see how to properly place and secure the magnet, so she can take care of it if it is displaced," she adds.
Nurses also are responsible for notifying the funeral home that an ICD is present, Kozak says. "An ICD can explode during cremation," she explains.
For more information about implantable cardioverter defibrillators and hospice, contact:
Janet Bull, MD, Chief Medical Officer, Four Seasons Hospice and Palliative Care, 571 S. Allen Road, Flat Rock, NC 28731. Telephone: (828) 233-0302. Fax: (828) 692-2365. E-mail: firstname.lastname@example.org.
Nathan Goldstein, MD, Assistant Professor, Hertzberg Palliative Care Institute, Mount Sinai School of Medicine, Annenberg Building, 10th Floor Room 10-22, 1468 Madison Ave., New York, NY 10029. E-mail: Nathan.Goldstein@mssm.edu.
Porter Storey, MD, Executive Vice President, American Academy of Hospice and Palliative Medicine, 4700 W. Lake Ave., Glenview, IL 60025-1485. Telephone: (847) 375-4712. Fax: (847) 375-6475. E-mail: email@example.com.
Chuck Wellman, MD, FAAHPM, Chief Medical Officer, Hospice of the Western Reserve, 300 E. 185th St., Cleveland, OH 44119. Telephone: (216) 383- 3775. Fax: (216) 383-3750.