A multidisciplinary quality improvement initiative to improve neonatal end-of-life care in a level IV NICU.

Overview

BACKGROUND: Palliative care interventions are underutilized in infants due to a knowledge deficit among providers surrounding neonatal end-of-life care and a pervasive lack of guidelines in neonatal intensive care units (NICUs). The aim of this study was to increase end-of-life symptom management by 50% and improve staff attitude scores and awareness of end-of-life cases by 20% by August 2024. METHODS: The Model for Improvement was used to examine the baseline of mortalities and test interventions to increase analgesia administration and improve staff attitude scores and awareness during end-of-life care. RESULTS: Fentanyl equivalent administration in the 24 h preceding death increased by 309% between epochs. A comparison of survey responses across epochs revealed a significant increase in staff comfort, confidence, preparedness, and awareness when providing end-of-life care. CONCLUSION: The creation of a multidisciplinary quality improvement (QI) team, the implementation of end-of-life guidelines, electronic health record (EHR) modifications, and staff education improved symptom management, staff attitude scores, and awareness when providing end-of-life care.