Abstract
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.
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Acknowledgements
We thank Kimberley A Fisher, PhD, and Carolyn Jones, MSN, NNP for their expert technical contributions (financial support provided by the Jean and George W Brumley, Jr Neonatal Perinatal Research Institute). Dr Smith receives salary support for research from the NIH and the US Department of Health and Human Services (government contract HHSN267200700051C, HHSN275201000003I, and UL1TR001117). Dr. Cotten received funding from NICHD: 5U10HD040492-10, from NHLBI: 1R01HL10570201A1 and from NIDDK: NIH-NIDDK203-2345. Dr. Brandon received funding from NIH-NINRR01NR010548.
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Younge, N., Smith, P., Goldberg, R. et al. Impact of a palliative care program on end-of-life care in a neonatal intensive care unit. J Perinatol 35, 218–222 (2015). https://doi.org/10.1038/jp.2014.193
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DOI: https://doi.org/10.1038/jp.2014.193
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