Evaluation of adherence to national regulations for documentation of limitations of life-sustaining treatments after a limited intervention at a Swedish hospital

Aim: The aim of this study was to improve adherence to the Swedish National Board of Health and Welfare’s regulations for documenting decisions regarding Limitations of Life-Sustaining Treatments at Capio St. Göran’s Hospital in Stockholm following a limited intervention. Methods: This was a before-and-after-study. The intervention took place in June 2023 and consisted of three parts: 1. Implementation of a modified digital medical record form for documentation of decisions regarding limitations of Life-Sustaining Treatments. 2. A brief educational intervention for physicians at the hospital. 3. Publication of an updated hospital protocol for decisions on limitations of Life-Sustaining Treatments. We analysed 100 randomly selected documentations of limitation of Life-Sustaining Treatments in adult patients before the intervention, and 98 after the intervention. Adherence to individual mandatory criteria and overall adherence to the regulatory requirements was evaluated. Results: Overall adherence to all documentation regulations increased from 1% to 63% ( p   0.99). All other individual criteria improved: consultation with another licenced caregiver (65–89%, p  < 0.01), dialogue with the patient or motivation why not (24–89%, p  < 0.01), information to the family or motivation why not (23–74%, p  < 0.01), the view of the patient (14–86%, p  < 0.01) and the view of the family (4–70%, p  < 0.01). Conclusion: A moderate intervention in terms of cost and work effort for the organisation can significantly improve adherence to regulations regarding documentation of limitations of Life-Sustaining Treatments, although further improvement is needed.