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Impact of a palliative care program on end-of-life care in a neonatal intensive care unit
N Younge1, P B Smith1, R N Goldberg1
1Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA.
Insights
Implementing a palliative care program in a neonatal intensive care unit increased end-of-life family meetings and benzodiazepine use. This suggests improved communication and adherence to guidelines for neonatal end-of-life care.
Area of Science:
- Neonatal Intensive Care Unit (NICU) care
- Palliative care
- End-of-life care
Background:
- Neonatal intensive care units (NICUs) face complex end-of-life care decisions.
- Palliative care programs aim to improve the quality of care for infants with life-limiting conditions.
Purpose of the Study:
- To evaluate the impact of a newly implemented palliative care program on end-of-life care practices in a NICU.
- To assess changes in medication use, life support withdrawal, and family meetings after program initiation.
Main Methods:
- A retrospective study design was employed, comparing two periods: before and after the implementation of the Palliative Care Program.
- Data on infant deaths, medication administration (morphine, benzodiazepines), life support withdrawal, and do-not-resuscitate (DNR) orders were analyzed.
- The program included medication guidelines, individualized order sets, nursing care plans, and staff education.
Main Results:
- A total of 82 infant deaths occurred before (Era 1) and 68 after (Era 2) program implementation.
- Benzodiazepine use significantly increased in Era 2 (43% vs 26%, P=0.03), while morphine use remained similar (88% vs 81%).
- Withdrawal of life support and DNR orders showed no significant difference between eras, but DNR orders and family meetings were more frequent in infants with activated palliative care orders in Era 2.
Conclusions:
- The palliative care program was associated with an increase in end-of-life family meetings and benzodiazepine use.
- These changes likely indicate improved communication and adherence to palliative care guidelines within the NICU.
- The findings suggest the program positively influenced end-of-life care communication and management.
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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