Improving mealtimes for paediatric intensive care children and families: A quality improvement initiative
burn out; family-centred care; meal service; post-intensive care syndrome; quality improvement; rehabilitation
INTRODUCTION: Many critically ill children can be fed orally at some point during their paediatric intensive care (PICU) stay, but reduced appetite and other factors may impact their intake. At home, oral feeding is usually delivered by parents, so involving parents more actively during mealtimes in the PICU may contribute to improved patient/family satisfaction. We aimed to assess the impact of a new "room service" initiative involving parents on mealtime quality and on both family and health care professional (HCP) satisfaction. METHODS: A prospective, single-centre, before-and-after intervention study was designed as part of a PICU quality-of-care improvement programme in 2013 to 2016. Two questionnaires assessing oral nutrition practices and family/HCP overall satisfaction were disseminated among the parents of critically ill children capable of oral feeding during their PICU admission and among the whole PICU HCP team (nurses, nurse assistants, and medical doctors). Categorical variables were compared using the chi-square test, and Likert scales were compared between groups with the Mann-Whitney-Wilcoxon test. RESULTS: the pre-intervention surveys were completed by 97 of 130 (75%) HCPs and 52 families and the post-intervention surveys by 74 of 130 (57%) HCPs and 54 families. After the intervention, a marked improvement was observed in the overall quality of meal service rating by both HCPs and families (medians and IQR: 5 (5-7) to 7 (7, 8) and 6 (6-8) to 8 (7-9), respectively; P < .01) and also in parents' involvement; in children's, families', and HCP satisfaction; in meal-dedicated facilities and equipment; and in perception that oral nutrition is an important aspect of PICU care. CONCLUSIONS: Implementation of an improved "room service" initiative in the PICU was feasible and improved the perceived quality of care and satisfaction around oral feeding. This family-centred care initiative can be integrated in an overall quality improvement strategy.
De Monte M; Marty Petit EML; Baudin F; Zamor J; Ford-Chessel C; Tume LN; Bordet F; Valla FV
Critical Care Nurse
2020
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/nicc.12567" target="_blank" rel="noreferrer noopener">10.1111/nicc.12567</a>
PO-0318 Team–family Conflicts In Decisions To Forgo Life-sustaining Treatment (lst) In Picu
Background and aims Many sources of conflict exist in intensive care units between family’s members, team–family, or within the ICU team. These conflicts are frequents (48%) in adults ICU, and most are in relation to end-of-life decisions especially with decisions to forgo LST. In PICU, no study has previously reported the prevalence, characteristics and effects of these conflicts. Methods We conducted a retrospective observational study of children admitted to PICU of Lyon, France, for whom a meeting to forgo LST had been held between October 1st 2010 and February 28th 2014. We search in medical record if conflict or disagreement were noticed and we interviewed the referent physician about conflict. We distinguished simple disagreement (quickly resolved), continuing disagreement (parents refuse recommendations with communication still possible), and conflict (communication impossible). Results For 72 children (31 girls, 41 boys), 91 decision-making meetings were organised. We identified 27.7% (20/72) disagreements or conflicts: 4 simple disagreements, 12 continuing disagreements and 4 conflicts. Five children had acute disease and 15 children had chronic disease. Source of disagreements was continuing LST in 19 cases (families wanted to continue aggressive treatment). In 1 case, the family wanted to stop treatments despite medical opinion (refusal of tracheotomy). Consequences of theses disagreements were continuation of treatments despite LST decisions in 12 cases. For 3 cases a compromise solution was found. Conclusion Disagreements are frequent in decisions to forgo LST (27,7%) and most of the child undergo treatments that are medically futile.
2014-10
Dalichoux B; Bordet F; Javouhey E
Archives Of Disease In Childhood
2014
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1136/archdischild-2014-307384.967" target="_blank" rel="noreferrer">10.1136/archdischild-2014-307384.967</a>
Withholding and withdrawing treatment in pediatric intensive care. Update of the GFRUP recommendations
Infant; Child; Palliative care; Pediatric critical care; Resuscitation orders; Treatment withdrawal; Treatment withholding
In 2005, the French-speaking task force on pediatric critical and emergency care [Groupe Francophone de Réanimation et d'Urgences Pédiatriques (GFRUP)] issued recommendations on withholding and withdrawing treatments in pediatric critical care. Since then, the French Public Health Code, modified by the laws passed in 2005 and 2016 and by their enactment decrees, has established a legal framework for practice. Now, 15 years later, an update of these recommendations was needed to factor in the experience acquired by healthcare teams, new questions raised by practice surveys, the recommendations issued in the interval, the changes in legislation, and a few legal precedents. The objective of this article is to help pediatric critical care teams find the closest possible compromise between the ethical principles guiding the care offered to the child and the family and compliance with current regulations and laws.
Cremer R; de Saint Blanquat L; Birsan S; Bordet F; Botte A; Brissaud O; Guilbert J; Le Roux B; Le Reun C; Michel F; Millasseau F; Sinet M; Hubert P
Archives of Pediatrics
2021
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.arcped.2021.03.004" target="_blank" rel="noreferrer noopener">10.1016/j.arcped.2021.03.004</a>