Bereavement follow-up: Listening and learning
bereavement;follow up;learning;Child;clinical article;conference abstract;consultation;diagnosis;Female;genetic transcription;Human;intensivist;Male;memory;nurse;staff;terminal care
Aims & Objectives: Providing family focussed care through lessons learned from bereavement follow-up. Methods RMCH is a tertiary PICU in UK with 750 admissions annually. Families of all patients who die in PICU are offered bereavement follow-up at 6-8 weeks. The meeting is attended by the parents, consultant intensivist and a family liaison nurse (recently appointed). As a service improvement project, these meetings have been routinely observed by a senior staff member using shadowing techniques (April 2017 onwards). Transcripts are recorded in a pre-designed field journal. Team debrief is held following meetings to identify recurrent themes to guide service improvement. Results 25 patients died between January-November 2017. 6 families attended bereavement follow-up. Families who attended had unanswered questions around care (pre-hospital/hospital) or were waiting to get the final postmortem /genetic test results. Two families declined as they were "happy with the care", three are awaiting follow-up dates and the remaining did not reply. To improve quality of discussions, team realised that prior interaction with parents to identify their objectives from the meeting is essential. Recurrent themes that emerged from shadowing technique included feedback around care (pre-hospital / in the hospital), communication gaps (during transfer of care, what to expect upon PICU admission, what happens after a child dies), making memories and wanting to know pending test results. Conclusions Families who have unanswered questions around care or diagnosis, tend to attend bereavement follow up. Shadowing technique has revealed what families want from end of life care and has helped to shape improvement in our service.
Subramanian G;Consterdine K;Ryan C
Pediatric Critical Care Medicine
2018
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/10.1097/01.pcc.0000537861.99545.54" target="_blank" rel="noreferrer noopener">10.1097/01.pcc.0000537861.99545.54</a>
Improving communication within multi-disciplinary teams in children with life limiting conditions
Multidisciplinary team;Child;conference abstract;constitutive androstane receptor;death;endogenous compound;Human;intensivist;nurse;Palliative therapy;patient referral
Aims & Objectives: 60% of children admitted to RMCH PICU might benefit from palliative care (previous case review). Co-coordinating and maintaining continuity of care in these children with multi-speciality input is challenging. Weekly Multi disciplinary Team Meeting (MDT) and follow up was introduced in PICU to improve care in this cohort. Methods Weekly MDT meeting (co-located specialist teams, Intensivists, palliative care consultant, family liaison nurses) were held over a year. Spectrum of Palliative Care Needs was used to 1. Recognise children who might benefit from palliative care 2. Identify need for MDT/Lead consultant/End of life discussions if not already done 3. Update community and specialist teams 4. Discuss/Review advanced care plan (ACP). Results Actions from 32 MDTs were analysed (minimum 2 meetings monthly) in children with palliative care needs (62%). Actions that had to take place within the hospital were completed: Liaising with specialist nurses: 7; Initiating ACP: 4; Identifying ICU lead: 16; Recognising need for end of life discussions, planning for death and place of death: 14; referral to in-house palliative care team: 17; Organising MDT: 11. However only 44% of local teams (outside hospital) were contacted (action that involved teams outside the hospital) and feedback from local teams after discharge was inconsistent. Conclusions Weekly MDT meetings to identify children who might benefit from palliative care are a good start to improving communication and maintaining continuity of care. More initiatives need to be taken by the intensivists in speciality hospitals to improve communication with the wider network of professionals looking after children with life limiting conditions.
Subramanian G;Consterdine K;Kauffmann L
Pediatric Critical Care Medicine
2018
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/10.1097/01.pcc.0000537863.07170.4e" target="_blank" rel="noreferrer noopener">10.1097/01.pcc.0000537863.07170.4e</a>