Addressing Perinatal Palliative Care Program Development (401)

Abstract

1.Describe criteria that can be used to define a target population who can benefit from perinatal palliative care.2.Identify potential barriers to developing a perinatal palliative care program.3.Describe strategies which can be implemented to overcome barriers and facilitate program success. UCSF Children's Hospital offers a bridge between our high risk obstetrics and fetal treatment programs and our regional Level 3 intensive care nursery (ICN) for families at risk for neonatal or fetal loss. Each year, pregnancy losses outnumber inpatient pediatric and neonatal deaths combined. As we developed our hospital-wide pediatric palliative care program in 2000, we quickly recognized unique needs around perinatal palliative care, requiring collaboration between the prenatal diagnosis center, high risk obstetrics, fetal treatment, and the ICN to comprehensively attend to the divide between aggressive treatment and possible loss. Program efforts have been directed at three overarching barriers to care: systems issues, lack of staff education, and communication and decision-making obstacles. Although informal practices and resources were available, we understood the need to formalize policies, to provide staff education and support, and to consistently mentor clinical practice. Because staff members were confused and anxious over accurately complying with specific state mandated laws around handling pregnancy loss and newborn death, initial efforts focused on delineating policies around paperwork and handling of the fetal remains. Several resources were also developed to improve communication between departments and inpatient/outpatient areas, such as quarterly interdisciplinary case reviews and palliative care (PC) meetings, in addition to documentation tools to facilitate communication. In an effort to promote consistent clinical practice, we developed standing orders for comfort care of the nonviable infant and neonatal PC guidelines for symptom management. We also standardized memento-making practices and grief literature. Repeated education around administrative policies, perinatal PC principles, and clinical resources were essential to enhance awareness, staff comfort level, and clinical care. The session will define the target population who can benefit from perinatal palliative care, present a model for how the program is implemented, and highlight the strategies used to address operational barriers to optimizing program success. Structure and Processes of Care