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Withholding and Withdrawing Life Sustaining

PATIENT ALERT:  Withholding and withdrawing life-sustaining therapy involve end-of-life decisions that commonly result in the death of the patient.
  1. With the patient, family, and health care team, coordinate a comprehensive plan for the process of withholding and/or withdrawing life-sustaining therapy.
  2. Ensure the patient, health care proxy, and/or family understand and agree to the process of withholding and/or withdrawing life-sustaining therapy.
  3. Ensure the patient, health care proxy, and/or family understand the probable outcome of withholding and/or withdrawing life-sustaining therapy.
  4. Allow the patient and family time to complete family affairs, communicate with each other, spend time together, and say goodbyes.
  5. Ensure the key members of the health care team are actively involved in the process of withholding and/or withdrawing life-sustaining therapy.
  6. In collaboration with the physician, determine the type of analgesics and other medications, such as anxiolytics; route of administration; dosage; and time that administration will be initiated.
  7. In collaboration with the physician, determine how medications for pain and other symptoms will be titrated to signs of patient's discomfort.
  8. Assist or place the patient in a preferred position of comfort.
  9. Lower the side rails if family and/or friends are present.
  10. Turn off all monitors.
  11. Ensure the family is present.
  12. Ensure the environment is as the patient or family wants it.
  13. Ensure the key members of the health care team are present (e.g., critical care nurse, attending physician, respiratory therapist, pastor).
  14. Initiate administration of pain medication as prescribed (e.g., low dose of pain medication; morphine, less than 5 mg/hr).
  15. Withhold or withdraw therapy.
  16. Titrate intravenous pain medication to signs of patient's distress.
  17. Support the patient and the family.
  18. Provide time for the patient and the family to be alone, if so desired.
  19. Assist the family with the grief process.
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