Withdrawal of Life-Sustaining Measures Order Form — University of Washington Schools of Medicine and Nursing Name: University of Washington/Harborview Medical Center - Integrating Palliative and Critical Care Program: Withdrawal of Life-Sustaining Measures Order Form Description:  A two page form for intensive care doctors and nurses containing a comprehensive list of steps to follow when withdrawing life-sustaining measures and a list of principles for withholding and withdrawing life-sustaining treatment. Category:  Educational Tools – Clinician Education Source:  University of Washington Harborview Medical Center 325 9th Ave., Box 359762 Seattle WA  98104 206.731.3356 Contact: J. Randall Curtis, M.D., M.P.H. ptreece@uwashington.edu How the grantee used this instrument:  Physicians and nurses read and signed the withdrawal of life-sustaining measures order form before beginning the recommended withdrawal procedures. Keywords: hospital, clinical training, grand rounds, clinical information, champions, educational posters To use this tool:  You may print and copy this tool from this site.  The information contained therein will need to be adapted for your site.  See the following website for updated versions:  http://depts.washington.edu/eolcare . References: Treece PD, Engelberg RA, Crowley L, Chan JD, Rubenfeld GD, Steinberg KP, Curtis JR. Evaluation of a standardized order form for the withdrawal of life support in the intensive care unit.  Critical Care Medicine 2004; 32:1141-1148. To view this tool: Withdrawal of Life-Sustaining Measures Order Form - 2 page PDF (Viewing PDF files requires downloading and installation of the free Adobe Acrobat Reader.) Posted: July 2006 Return to top Return to the University of Washington School of Medicine and Nursing Promoting Excellence in End-of-Life Care was a national program of the Robert Wood Johnson Foundation dedicated to long-term changes in health care institutions to substantially improve care for dying people and their families.