The following resources and tools are meant to be adopted or adapted by hospitals, intensive care units, and organ donation organizations to support implementation of the Canadian Critical Care Society guideline for Withdrawal of Life Sustaining Measures (WLSM).
The WLSM process is complex and made even more complex by the introduction of consent for donation after circulatory determination of death and the necessary preparation processes. A checklist for the team to review prior to the process of WLSM was developed.
An additional section for donation after circulatory determination of death highlights those special considerations for DCD potential donors. Also see donation after circulatory determination of death for additional DCD resources.
WLSM Documentation Tool
A documentation tool that links symptoms, drug administration, and response to treatment was developed.
WLSM Information for Families
Families and health care professionals reflected on the need for written documentation and tools to assist families in understanding the complexity of the actions that occur prior to, during, and after the WLSM.
The information leaflet assists families in receiving information in multiple formats when information is most difficult to absorb. Also see donation after circulatory determination of death for additional DCD resources for families.
WLSM Order Set
The order set exists as a clear plan for symptom management, developed and discussed in advance of apparent symptoms, so health-care professionals and families/substitute decision makers are clear on a plan.
WLSM Policy Template
While individual needs for a policy framework will vary from hospital to hospital, it is often helpful to begin with a common structure and tailor the specific policy to meet the needs and interests at the hospital. This policy framework provides minimum specifications to implement the Canadian Critical Care Society’s WLSM guideline effectively.
WLSM Case Audit Tool
Organ donation committees, ICU councils, or intensivists may wish to audit a series of WLSM cases in a random or systematic sampling after the WLSM guideline has been implemented.
This tool, to be used on a case by case basis, evaluates adherence to components of the WLSM guideline recommendations. Cumulative analysis of a series of cases of WLSM may identify opportunities for process improvement within the hospital.
WLSM System Audit Tool
It is necessary to understand and measure whether the WLSM guideline has been implemented in various hospital systems. This is of interest to hospitals and organ donation organizations who support DCD processes.
This resource is a list of recommended requirements at a hospital level that would be put into place, in advance of cases of WLSM, to support professionals and families in the process, as determined by the guideline.
This tool could be used by the organ donation organizations to engage in communication with the hospital stakeholders around quality management in this regard.
Guiding principles for implementation of the WLSM guideline in DCD practice are available here.