748 End of Life Care Plans (ELCP) in Children with Life Limiting Conditions

Abstract

Background and aim: Paediatricians face acute situations with children with life limiting illness, wherein resuscitative medical interventions should not be attempted. We aim to survey current prevailing practices on provision of ELCP in children who fulfil the criteria for life limiting illness in the London borough of Haringey, UK. Methods: Survey was conducted in the last quarter of 2009. A list was compiled of medical conditions deemed as life-limiting in children. Medical notes of all children on the list were reviewed, directing attention to the specific points that were noted as relevant in the audit proforma. Ethical issues were discussed with the clinical governance department at Great Ormond Street Hospital, London, UK. Results: 18 children with life limiting illness were resident in Haringey. 10 of the 18 (55.5%) children suffered from cerebral palsy. 13 of these children (72.2%) fulfilled criteria for the provision of an End of Life Care Plan (ELCP). 3 children of the 13 (23%) had an ELCP. Only one child had the ELCP documented and communicated to professionals appropriately. Conclusions: National standards for delivering end of life care for children are currently not being met, and children with complex neurodisabilities are not usually being appropriately considered for ELCP discussion. Professionals are uncomfortable with approaching and addressing the issue of ELCP in eligible candidates. A programme for training and support at all levels of service delivery - consultants, registrars and nursing staff should be developed and implemented.