Report of the National Consensus Conference on Family Presence During Pediatric Cardiopulmonary Resuscitation and Procedures

Abstract

Representatives from 18 national organizations were convened for a conference to develop recommendations regarding family presence (FP) during pediatric procedures and cardiopulmonary resuscitation. Before the conference, invitees were given a questionnaire and provided with current literature regarding FP. A modified Delphi process was used to develop consensus, including use of multiple questionnaires and breakouts for discussion of specific issues. Participants were encouraged to develop consensus recommendations based on the literature and discussions. Changes in attitude were tracked with repeat questionnaires. Results of the conference were circulated to participants for review and revision. Consensus recommendations include (1) consider FP as an option for families during pediatric procedures and cardiopulmonary resuscitation, (2) offer FP as an option after assessing factors that could adversely affect the interaction, (3) if family is not offered the option for FP, document the reasons why, (4) always consider the safety of the health care team, (5) develop in-hospital transport and transfer policies and procedures for FP, such as family member definition, preparation of the family, handling disagreements, and providing support for the staff, (6) obtain legal review of policies, (7) include education in FP in all core curricula and orientation for health care providers, (8) promote research into best methods for education; effects of FP on patients, family, and staff; best practices for FP; and legal issues regarding FP, among others. These recommendations were approved in concept by the American Academy of Pediatrics and the Ambulatory Pediatrics Association.

Death of a Child in the Emergency Department

“…18 Initial resistance to allowing family presence during attempted resuscitation was based on fears of litigation and concerns that the emotional burden for family members of watching resuscitation would create situations that would distract ED personnel, potentially interfere with effective resuscitation efforts, and only add to a family' s burden of grief. These fears have been systematically studied and for the most part clarified or eliminated.…”

“…Supportive articles have appeared in the ethics literature, the resuscitation literature, and the general and pediatric emergency medicine and nursing literature. [18][19][20][21][22][23][24][25][26][27] The Emergency Nurses Association (ENA), AAP, and ACEP have position statements on family presence. [24][25][26] The revised jointly issued policy statement from the AAP, ACEP, and ENA recommends that all EDs caring for children have a written policy regarding family presence.…”

Family Presence During Resuscitation and Invasive Procedures in Pediatric Critical Care: A Systematic Review

“…5 Family-centered care is also endorsed by the top children's hospitals in the United States and recognized and supported by the Institute of Medicine, the National Patient Safety Foundation, the Institute for Healthcare Improvement, and the National Institute for Children's Healthcare Quality. 6 Although family presence is endorsed by many medical and nursing organizations with published guidelines, variation in practice and opinion persists among health care providers, specifically with regard to resuscitation and invasive procedures. Often, providers are reticent to encourage parent presence.…”

Patient- and Family-Centered Care and the Role of the Emergency Physician Providing Care to a Child in the Emergency Department

“…2 acuity in the ED may result in delay or disruption of care, challenging the ability of ED staff to provide respectful and sensitive care. The lack of a previous relationship between patient/family and health care professionals and the acute nature prompting an ED visit can make it difficult to create an effective partnership.…”