Improving neonatal palliative care through end-of-life checklists

Categories: Care.

Karen McDonald, DNP, from Christiana Care Health System in Newark, Delaware had this to say: “To avoid healthcare and information disparities among our patients and their families, checklists and other forms should be present on the chart of every baby who receives palliative care in the NICU,”  when she presented the findings at the National Association of Neonatal Nurses 29th Annual Educational Conference in Nashville, Tennessee.

Dr. McDonald and her colleagues say they became “very passionate” about palliative care and decided to learn more about it so that they could start their own team. A team approach to palliative care has been shown to improve neonatal pain management, reduce the number of procedures that are performed, and produce better quality care during the end-of-life period.

To facilitate their research into what was being done in their NICU prior to starting the palliative care team, they created a data collection tool that looked at demographics and whether or not parents were involved in their child’s end-of-life care and pain control. The research showed that if something was not on the checklist, it did not get done. They also found that 68 – 80% of important end-of-life interventions were undertaken when a checklist was available at the bedside. These interventions included taking pictures of the baby before and after death to be given to the parents, providing a memory box and letting the parents hold the baby at the time of death. But if important interventions were not on the checklist, they were not completed on a routine basis, including pain control, making sure the parents were told about compassionate extubation (where the baby is taken off life support and allowed to die naturally), and having a do-not-resuscitate order on the patient’s chart.

“Palliative and end-of-life care is one of the important services that we as neonatal care nurses and neonatal nurse practitioners provide, and research has shown better coping skills for parents if consistent end-of-life care is provided. A checklist helps these things to be accomplished,” Dr McDonald explained. She also spoke of how palliative care can empower parents to make decisions and give the a better understanding of the child’s prognosis.

This abstract (Abstract number 1068) was presented at the National Association of Neonatal Nurses (NANN) 29th Annual Educational Conference.

Click here to read the full article on the Medscape Medical News website.