G532(P) The care never stops: improving child death management

Abstract

<h3>Context</h3> Every year almost 3000 children and young people die between the ages of 1 and 19 (ChildBereavementUK). The care that a child receives from medical professionals around the time of their death has lifelong implications for the family. <h3>Problem</h3> At our hospital 70% of paediatric staff surveyed were not confident to offer support to bereaved families. <h3>Assessment of problem and analysis of its causes</h3> The current bereavement leaflet was out of date and only relevant to the death of an adult. The staff surveyed felt they had not had adequate training. Interventions Development of an updated Paediatric Bereavement Support Pack containing relevant information to support bereaved families and guidelines for staff on completion of legal formalities Training to increase the confidence of paediatric doctors and nurses in supporting bereaved families Training to improve the confidence and understanding of the procedures required after a child has died <h3>Study design</h3> We surveyed 22 doctors and nurses working across the paediatric department including the ward, the paediatric emergency department and the special care baby unit. We asked them whether they were aware of the current bereavement pack, how to access it and whether they knew what support was available to grieving families. We asked them to identify agencies and professionals who should be informed of the death of a child. <h3>Strategy for change</h3> We used a focus group to guide our development of a new leaflet appropriate for the death of a child and sensitive to a multicultural society. This highlighted that a checklist would be useful. The checklist included legal documentation required, professionals and agencies to inform, and references bereavement support references. We created bereavement packs containing all essential forms, the checklist and the updated bereavement leaflet and placed them in each of the main paediatric hospital departments. We conducted several multidisciplinary teaching sessions involving the named consultant for child death, the named nurse for safeguarding and a representative from the Child Death Overview Panel. They aimed to demystify the processes surrounding child death and to increase people’s confidence in dealing with the death of a child. <h3>Measurement of improvement</h3> Following our interventions and training we used the same questions to reassess the knowledge and confidence of 22 paediatric doctors and nurses. <h3>Effects of changes</h3> Awareness of the bereavement pack increased from 55%(12) to 100%(22). Awareness of support available to families increased from 36%(8) to 95%(21). Before our interventions 55%(12) people surveyed were aware of the name of the named doctor for child death and afterwards 86%(19). Only 40%(9) of people surveyed before our interventions were aware of more than 3 agencies that needed to be informed of the death of a child; this rose to 82%(18) after the interventions. All of the agencies are listed on the checklist included in the pack. Overall the confidence level of staff to support newly bereaved families improved from 23%(5) to 55%(12) (Figure 1). Feedback from the teaching described it as “informative”, “interactive” and “a clear pathway”. <h3>Lessons learnt</h3> This study demonstrated the lack of confidence and knowledge of paediatric staff in management of child death and support of bereaved families. Our training and interventions improved confidence in dealing with child death. <h3>Message for others</h3> Consultation with nursing and medical staff involved in child death is important in ensuring useful checklists and training. However, as child death is an infrequent and stressful event regular teaching is required to maintain and strengthen confidence.