Utility of morbidity and mortality conference in end-of-life education in the neonatal intensive care unit.
BACKGROUND
A monthly neonatal intensive care unit (NICU) morbidity and mortality conference (M&MC) was used to study the documentation of end-of-life (EOL) care, and integrate related education for staff and trainees.


OBJECTIVE
To study the current documentation of comprehensive, interdisciplinary, palliative EOL care in the NICU at the Vanderbilt Children's Hospital and improve it relative to a historical background.


METHODS
A survey tool was developed and used at all neonatal M&MCs for 1 year (August 2003 through July 2004), in conducting a prospective chart audit of 50% of NICU deaths. The survey ascertained documentation of EOL care to include the anticipation of death by family and staff; provision of pain management; discussion of ethical and EOL decision-making issues; and the use of supportive services. Clinical education and literature references pertaining to these elements of care were presented in the conferences.


RESULTS
Twenty-six surveys were completed (48% of deaths in NICU over the study period). Documentation of EOL care ranged from excellent (pain management, 100%) to poor (spiritual support, 54%). Documentation of all other measures varied from 69% to 92%. Staff and trainees reported educational enhancement of the M&MC, and greater awareness of issues important to EOL care throughout this period.


CONCLUSIONS
Areas for improving EOL care exist in the NICU. The M&MC is a familiar venue for incorporating EOL care education for staff and trainees. A survey tool may serve to aid in the assessment of documentation of such care. Staff awareness of, and attention to, EOL issues may be improved through such a mechanism.
Carter
Brian Scott
BS
Department of Pediatrics/Neonatology, Vanderbilt Children's Hospital, Nashville, Tennessee 37232-9544, USA. Brian.Carter@vanderbilt.edu
Guthrie
Scott Osborn
SO
D001293:Attitude to Death; D006776:Hospitals, Pediatric; D006785:Hospitals, University; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007318:Inservice Training; D007363:Intensive Care Units, Neonatal / Q000941:ethics / Q000592:standards*; D008485:Medical Audit; D008505:Medical Staff, Hospital / Q000193:education; D009017:Morbidity; D009359:Neonatology / Q000193:education* / Q000941:ethics; D009741:Nursing Staff, Hospital / Q000193:education; D010166:Palliative Care; D010865:Pilot Projects; D015397:Program Evaluation; D011785:Quality Assurance, Health Care / Q000458:organization & administration; D012947:Social Work / Q000193:education; D013192:Staff Development; D013714:Tennessee; D013727:Terminal Care / Q000592:standards*