Implementing a Palliative Care Program in a Newborn Intensive Care Unit

Abstract

Method: A 26 question anonymous survey was sent via email to medical staff at 4 tertiary NICU's and neonatal transport service in Victoria. Demographic response data was collected and responses were collated and compared in 2groups-hospital clinical photography and smart phone clinical images. Results: 124 participants were invited and 54 completed surveys were received (43%). 45 (84%) of respondents reported using hospitalclinical photography and 48 (89%) reported use of smart phones for obtaining clinical images. The majority of respondents reported clinical photographs were taken by medical staff (n = 33, 39%). Smart phone clinical images were used for consultation (50%). There was limited awareness of clinical photography guidelines by medical staff. Conclusions: This study demonstrates that neonatal medical staff are poorly informed as to institutional clinical photography guidelines and procedures for consent, storage and distribution. This highlights the need for appropriate clinical governance for clinical photography, keeping pace with technological advances, to reduce possible breeches in patient privacy and medicolegal risk. Background: In 2014, the leaders of world organisations challenged professional health bodies to be involved in achieving the targets of The Every Newborn Action Plan and Sustainable Development Goals. In Papua New Guinea (PNG), the Australian College of Neonatal Nurses is supporting health workers through the provision of education, training and resources, to improve maternal and newborn outcomes. Method: Biannual delegations of up to eight health professionals spend one week teaching local nurses, midwives and other health workers evidence-based clinical skills, global initiatives and quality improvement skills. Results: Basic resuscitation skills have been acquired by 561 members of the health workforce. Local nurses and midwives now lead clinical community training programs. Quantitative assessment demonstrates effective knowledge acquisition while anecdotal evidence reports successful resuscitations in rural contexts. Research grand rounds has been attended by 282 clinicians. The results of one practice improvement project has been presented at an international forum and another is currently being planned. Four clinicians have been supported to attend conferences abroad. Conclusions: Time, trust, respect and shared learning has resulted in a number of positive outcomes in nursing and midwifery care. The challenge remains to continue monitoring the effect on morbidity and mortality of mothers and newborns in this region of PNG. Background: When active treatment is no longer in the best interests of the patient, redirection of care to palliation is an important transition, but the adequacy of that transition pathway in the neonatal population is poorly described. Methods: Neonatal deaths from 2006-2015 in a single tertiary centre were identified and the medical notes reviewed. The adequacy of documentation, treatment interventions, symptom control and family supports were asses...

Communicating With Children and Families: From Everyday Interactions to Skill in Conveying Distressing Information

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Extremely long hospitalizations of newborns in the United States: Data, descriptions, dilemmas

“…Although a protocol for palliative care for marginally viable infants has been written about since 2002 [26][27][28][29] and put into practice in select US hospitals, [30][31] nurses and physicians in this study described lack of agreement on the implementation of end of life palliative care. Nurses described physicians or parents insisting upon treatments that nurses could see were futile.…”

Parent Involvement in End-of-Life Care and Decision Making in the Newborn Intensive Care Unit: An Integrative Review

“…Palliative care conferences assist parents in making decisions about treatments their infant may receive (Carter & Guthrie, 2007;Gale & Brooks, 2006;Pierucci et al, 2001). Pierucci et al (2001) noted that, in their study, the NICU infants whose parents had palliative care consultations had fewer resuscitation attempts and more withholding of mechanical ventilation and cardiac medications than infants whose parents did not have consultations.…”

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“…There is growing recognition of the importance of palliative care for the dying infant and the family. Palliative care emphasizes quality of life while alleviating the symptoms of medical conditions and their treatments (Gale & Brooks, 2006;Sumner, Kavanaugh, & Moro, 2006). …”