Compassionate extubation protocol to improve team communication and support in the neonatal intensive care unit

Abstract

Objective Compassionate extubation (CE) can be stressful for staff and families in the neonatal intensive care unit (NICU). Our quality improvement initiative developed and implemented a novel symptom management and family support checklist and post-debriefing template to improve team communication and staff support. Study design An interprofessional team performed a needs assessment, determined key drivers and intervention steps, and implemented changes using Plan-Do-Study-Act cycles. Outcomes included nursing perception of good communication with the medical team, nursing assessment of patient comfort after CE, and frequency of post-event debrief. Outcomes were analyzed using time series design with 12 months baseline data and 6 months post-implementation monitoring. Result Eighteen events were studied. Respondents endorsing "good" communication with the medical team increased by 60%, and debrief participation rate improved by 96%. Conclusion Implementation of a CE checklist and post-event debriefing sheet was associated with increased rate of debriefs and improved team communication.

Palliative Extubation in Pediatric Patients in the Intensive Care Unit and at Home: A Scoping Review

“…The study of Donoho et al (USA, 2021) is a retrospective review and a quality improvement project directed at nursing staff and is aimed at developing and implementing a symptom management and family support checklist and postdebriefing template to improve team communication and staff support at a Neonatal ICU [ 21 ].…”

“…Donoho et al included (1) patients who underwent PALEXT in Neonatal ICU and (2) healthcare professionals who cared for patients who underwent PALEXT [ 21 ]. Out of 50 total deaths during the initial 12-month review, 29 (58%) occurred following PALEXT.…”

“…The ability to locate the PALEXT checklist varied by role: more attendings and fellows than nurses of respiratory therapists. The checklist and debriefing were helpful for ensuring staff support during a PALEXT event [ 21 ].…”

“…Donoho et al in a retrospective cohort of 29 cases found a median time PALEXT to death of 01 h 02 min (ranging from one minute to 33 days and 14 hours). During the 6-month intervention period, the 18 neonatal PALEXT cases had the median time to death after PALEXT that was 01 h 22 min (ranging from 18 minutes to two days, 21 hours and 18 minutes) [ 21 ].…”

“…Donoho et al developed and implemented a novel symptom management and family support checklist and postdebriefing template to improve team communication and staff support [ 21 ]. Eighteen events were studied.…”