Transition to a Primary Palliative Care Model in the NICU (FR441B)

Transition to a Primary Palliative Care Model in the NICU (FR441B)

Brown H; Bruner A; Baxter R

Journal of Pain and Symptom Management

2020

comfort; conference abstract; controlled study; documentation; education; female; hospice; human; human experiment; infant; male; needs assessment; neonatologist; nurse; palliative therapy; satisfaction

Objectives: * Compare the benefits of a primary palliative care model to those of a specialty palliative care service. * Propose a stepwise process to initiate the transition from a specialty palliative care service to a primary palliative care service. * Identify the need for increased primary palliative care services to reduce the burden on specialists and increase PC availability to a larger population. Background Transitioning from a specialist palliative care service (SPCS) to primary palliative care (PPC) model in the Neonatal Intensive Care (NICU) requires a systematic approach. A needs assessment identified the high-value staff place on palliative care (PC) services and the desire for the primary care team to serve as the PPC providers. Aim Statement One goal is to reduced fragmentation of care while promoting improved communication amongst the interdisciplinary team. Utilization of attending physicians for PPC is projected to reduce to the demands of the PC specialist and better meet the PC needs. Methods A staff survey serves as a baseline needs assessment. The “Trigger” system is initiated to identify PC babies. An automatic “banner” placed in the electronic healthcare record identifies PC involvement for all healthcare providers. A “Champions” group instituted interdisciplinary PC education for the staff. Weekly bedside interdisciplinary rounding, with family involvement, has been instituted. The same survey was re-distributed for comparison. Results Family support by the PCP model rates 87.5%, compared to 86.96% with SPCS. Staff and family communication in the PCP model (87.5%) improved when compared with SPCS (54.35%.) Initially, 37% of staff recognize palliative care apart from hospice. One-hundred percent recognize the full scope of PC following the deployment of the triggers and education. Staff comfort levels in palliative discussions and frequency in care conferences improved. Staff identifies the continued need for further ongoing education and ease of documentation. A majority of the staff (72%) favor the PCP model over the SPCS of palliative care in the NICU setting. Conclusions and Implications Transitioning from SPCS to a PPC model improves communication and satisfaction amongst NICU nurses. The availability of PC services expands by providing further PC education to the staff and utilizing attending neonatologists to provide basic PC services.

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March 2020 List