Impact of a palliative care program on end-of-life care in a neonatal intensive care unit.

OBJECTIVE: Evaluate changes in end-of-life care following initiation of a palliative care program in a neonatal intensive care unit. STUDY DESIGN: Retrospective study comparing infant deaths before and after implementation of a Palliative Care Program comprised of medication guidelines, an individualized order set, a nursing care plan and staff education. RESULT: Eighty-two infants died before (Era 1) and 68 infants died after implementation of the program (Era 2). Morphine use was similar (88% vs 81%; P =0.17), whereas benzodiazepines use increased in Era 2 (26% vs 43%; P=0.03). Withdrawal of life support (73% vs 63%; P=0.17) and do-not-resuscitate orders (46% vs 53%; P=0.42) were similar. Do-not-resuscitate orders and family meetings were more frequent among Era 2 infants with activated palliative care orders (n=21) compared with infants without activated orders (n=47). CONCLUSION: End-of-life family meetings and benzodiazepine use increased following implementation of our program, likely reflecting adherence to guidelines and improved communication.

Duke Scholars

Author Noelle Elizabeth Younge Pediatrics, Neonatology

Author Phillip Brian Smith Pediatrics, Neonatology

Author Ronald Norman Goldberg Pediatrics, Neonatology

Author Debra Huffman Brandon School of Nursing

Author Charles Michael Cotten Pediatrics, Neonatology

Author Margarita Bidegain Pediatrics, Neonatology