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J Perinatol. 2015 Mar;35(3):218-22. doi: 10.1038/jp.2014.193. Epub 2014 Oct 23.

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

Author information

1
Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA.

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.

PMID:
25341195
PMCID:
PMC4491914
DOI:
10.1038/jp.2014.193
[Indexed for MEDLINE]
Free PMC Article

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