• Any consultant directly involved in the patient’s care can authorise deactivation of a patient’s ICD once a decision on DNACPR has been made.
• Patients who are approaching end of life who have ICDs in situ should be considered for deactivation of the ICD. This ensures that inappropriate, distressing and futile shocks are avoided in the dying process.
• The timing of deactivation can be difficult and a discussion with patients and their families is essential so that patients understand the rationale behind deactivating the ICD and have the opportunity to ask any questions they may have.
• For difficult cases, the cardiology team would be happy to discuss timing and appropriateness of deactivation.
• If a decision for DNACPR has been made in a patient with an ICD, please follow these steps:
  • Ensure DNACPR/Respect form is completed.
  • Consultant to enter the following note on physiological measurement Trak request: ‘this patient has a DNACPR form. I authorise deactivation of the ICD'.
  • Member of team to contact Physiological Measurement Department on ext 26576 or ECG bleep 6576 during working hours of 0900 – 1700 and physiology staff will attend to deactivate the device.
  • In the emergency setting/out of hours when an ICD is delivering shocks or a patient is imminently dying, when there is not immediate access to staff members who are able to deactivate the device, the ICD should be temporarily deactivated by placing a magnet over the device.

Magnets

• Each magnet unit is supplied in a plastic pocket and has instructions for use clearly labelled. The instructions read:
  • The magnet should be placed over the ICD and kept in position using tape.
  • The magnet mode does not disable bradycardia pacing. Removal of the magnet allows the ICD to function as it did before magnet application.
• Dedicated magnets have been distributed at key sites at Borders General Hospital and relevant staff at these sites have been informed of their location.
• Magnets are available at the following BGH locations:
  • Ward 5 - 2 magnets
  • A&E - 1 magnet
  • Cardiology department - 5 magnets
• The remaining magnets (up to a maximum of 20) will be rolled out to other clinical areas depending on future need. The distribution list will be updated as required to reflect this.

Device company support, for training of clinical staff in deactivation of ICDS, is being explored.

An up-to-date list of known patients with ICDs and CRT-Ds in the Borders region will be circulated to relevant staff, including mortuary staff, when available and an additional list of patients with pacemaker and REVEAL devices may also be generated.