In a regional neuro trauma unit consent was gained for 53 out of 56 potential DBDs for the period 2013-16, an overall rate of 94.6% (2013–14 17/17 100%, 2014-15 18/21 86%, 2015-16 18/18 100%). 
In 2016-17 our consent rate fell to 11/18 61% which is below the national average of 69%. Review of our practice revealed no obvious changes.  In an attempt to increase our consent rate, we decided to focus on family information. 
It has been our practice to invite families to observe the second set of tests for many years. In December 2016 we chose to update a leaflet that had been used previously on the ICU which helped explain death by neurological criteria and the tests needed to diagnose this. In order to assess how this change was working we used a PDSA cycle.
The PDSA includes 3 cycles to date. The 1st cycle was review and revision of the leaflet by the SNODs and intensivists. The 2nd cycle involved asking all stakeholders, including all ICU staff (medical, nursing, AHPs and domestics) for feedback on the leaflet. The 3rd cycle starting in January 2017 was the introduction of the leaflet. The leaflet was given to families whose relatives were to undergo neurological death testing. To date there have been 16 leaflets given to a potential 29 families. 
The consent rate since January 2017 to October 2018 so far has risen to 71%. Since April to October 2018 the consent rate has risen to 80%. Further PDSA cycles are planned with the intention to implement this in the region to be used in all of our hospitals.

[P166] Diagnosing Neurological Death: A Relative’s Information Leaflet