Brian Scott Carter1, Scott Osborn Guthrie. 1. Department of Pediatrics/Neonatology, Vanderbilt Children's Hospital, Nashville, Tennessee 37232-9544, USA. Brian.Carter@vanderbilt.edu
Abstract
BACKGROUND: A monthly neonatal intensive care unit (NICU) morbidity and mortality conference (M&MC) was used to study the documentation of end-of-life (EOL) care, and integrate related education for staff and trainees. OBJECTIVE: To study the current documentation of comprehensive, interdisciplinary, palliative EOL care in the NICU at the Vanderbilt Children's Hospital and improve it relative to a historical background. DESIGN/ METHODS: A survey tool was developed and used at all neonatal M&MCs for 1 year (August 2003 through July 2004), in conducting a prospective chart audit of 50% of NICU deaths. The survey ascertained documentation of EOL care to include the anticipation of death by family and staff; provision of pain management; discussion of ethical and EOL decision-making issues; and the use of supportive services. Clinical education and literature references pertaining to these elements of care were presented in the conferences. RESULTS: Twenty-six surveys were completed (48% of deaths in NICU over the study period). Documentation of EOL care ranged from excellent (pain management, 100%) to poor (spiritual support, 54%). Documentation of all other measures varied from 69% to 92%. Staff and trainees reported educational enhancement of the M&MC, and greater awareness of issues important to EOL care throughout this period. CONCLUSIONS: Areas for improving EOL care exist in the NICU. The M&MC is a familiar venue for incorporating EOL care education for staff and trainees. A survey tool may serve to aid in the assessment of documentation of such care. Staff awareness of, and attention to, EOL issues may be improved through such a mechanism.
BACKGROUND: A monthly neonatal intensive care unit (NICU) morbidity and mortality conference (M&MC) was used to study the documentation of end-of-life (EOL) care, and integrate related education for staff and trainees. OBJECTIVE: To study the current documentation of comprehensive, interdisciplinary, palliative EOL care in the NICU at the Vanderbilt Children's Hospital and improve it relative to a historical background. DESIGN/ METHODS: A survey tool was developed and used at all neonatal M&MCs for 1 year (August 2003 through July 2004), in conducting a prospective chart audit of 50% of NICU deaths. The survey ascertained documentation of EOL care to include the anticipation of death by family and staff; provision of pain management; discussion of ethical and EOL decision-making issues; and the use of supportive services. Clinical education and literature references pertaining to these elements of care were presented in the conferences. RESULTS: Twenty-six surveys were completed (48% of deaths in NICU over the study period). Documentation of EOL care ranged from excellent (pain management, 100%) to poor (spiritual support, 54%). Documentation of all other measures varied from 69% to 92%. Staff and trainees reported educational enhancement of the M&MC, and greater awareness of issues important to EOL care throughout this period. CONCLUSIONS: Areas for improving EOL care exist in the NICU. The M&MC is a familiar venue for incorporating EOL care education for staff and trainees. A survey tool may serve to aid in the assessment of documentation of such care. Staff awareness of, and attention to, EOL issues may be improved through such a mechanism.
Authors: Dan Schwarz; Ryan Schwarz; Bikash Gauchan; Jason Andrews; Ranju Sharma; Gregory Karelas; Ruma Rajbhandari; Bibhav Acharya; Kedar Mate; Amir Bista; Megha Giri Bista; Colin Sox; Duncan Smith-Rohrberg Maru Journal: BMJ Qual Saf Date: 2011-09-26 Impact factor: 7.035