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

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.