Difficulties associated with implantable cardioverter defibrillator (ICD) deactivation—three main themes
| Themes | Examples of comments |
|---|---|
| 1. Reasons for limited access to ICD deactivation | |
| Poor out-of-hours access | “Unable to deactivate out of hours” “No availability of staff or a magnet to deactivate out of hours in a community hospital” |
| Unavailable in the community or hospice | “Difficulty getting ICDs inactivated as outpatients or when hospice inpatient” “Patients in the community—Unable to access anyone to come out and deactivate in a dying patient” |
| Excessive time delays | “Delays, particularly in the community setting” “Delays due to lack of defined process in the community” |
| Lack of access to magnets | “Unavailability of magnets for temporary deactivation” “Needed to obtain magnet from CCU out of hours in order to deactivate ICD” |
| Insufficient education on ICD deactivation | “Confusion around size of magnet needed” “…difficult to arrange availability of magnet and to ensure education on how to use one” |
| Organisational difficulties | “Access to technician support in the community—organised eventually but took lots of phone calls” “No local policy to my knowledge” “Took time to make contacts to arrange deactivation of ICD. Would be good to have regional flow charts on procedure for deactivation and contact numbers” |
| 2. Issues surrounding ICD deactivation that require improvement | |
| Decision-making on ICD deactivation | “Cardiology team reluctant to take the lead on decision-making” “Electrophysiology services unwilling to have conversations and make decisions (regarding) turning off ICDs” |
| Advance care planning: pre-empting ICD deactivation | “Not thought about early enough, unable to deactivate in time” “Lack of forward planning at times in the community” “Prior discussions on deactivation—that have not been had early enough” |
| Communication issues related to ICD deactivation | “Problems more associated with difficult communication issues” “Medical team reluctant to discuss with patient” “Need to ensure discussion about deactivation occur at insertion” “These discussions take place at the point at which they are inserted but are usually forgotten by the time they come into focus” “Patients not knowing they will need to be deactivated” |
| 3. Patient-related barriers to deactivation | |
| Patient reluctance or refusal to deactivate their ICD | “Patient was against having ICD deactivated” “Patient was reluctant to the idea of turning the device off” “…patient did not want it deactivated but his family did” |
CCU, Coronary Care Unit.