A study of the documentation of withholding and withdrawing life‐sustaining therapies in a tertiary intensive care unit in Hong Kong

Abstract Background In the Intensive Care Unit (ICU), recommended end‐of‐life (EOL) care practice encompasses do‐not‐attempt cardiopulmonary resuscitation (DNACPR), withholding (WH), and withdrawing (WD) life‐sustaining treatment (LST). Objectives Our study aims to evaluate the adequacy of physicians' documentation of EOL care practices. Methods We conducted a retrospective observational study, which evaluated the documentation of 18 pre‐identified critical components related to decision‐making, implementation, and communication of WD and WH of LST in a general medical‐surgical ICU of a tertiary hospital in the Hong Kong Special Administrative Region (HKSAR) of the People's Republic of China. One hundred twenty‐nine patients with EOL care before death were enrolled from 1 January 2013 to 31 March 2015. For documentation to be considered clear, the responsible ICU physician had to record notes in written form on the medical record. Results In documenting the decision‐making process, the indication of patients' decision‐making capacity was present in 6.2% of the reviewed records. DNACPR orders were documented substantially poorer (51.6%) than WH/WD other LSTs (71.4%–96.9%) in documenting the implementation process. Reviewing the communication documentation showed that 15.5% detailed the process of determining the patient's previously expressed wishes, 16.3% included explanations of shared decisions and 5.4% covered substituted decisions. None of the patient records met the complete documentation criteria while 17% met the minimal compliance level, defined as records missing 30% or fewer items. Conclusions Despite following international standards for EOL care, documentation by ICU physicians for key aspects of decision‐making, implementation, and communication for LST limitations was inadequate. Strategies to improve documentation should be encouraged.