Implementation of a Multidisciplinary Clinical Practice Guideline for Neonatal End-of-Life Care in a Level IV NICU

Background Palliative care interventions are underutilized in infants due to a knowledge deficit among providers surrounding neonatal end-of-life care and a pervasive lack of guidelines in neonatal intensive care units (NICUs). The aim of this study was to increase end-of-life symptom management by 50% and improve staff attitude scores and awareness of end-of-life cases by 20% by August 2024. Methods The Model for Improvement was used to examine the baseline of mortalities and test interventions to increase analgesia administration and improve staff attitude scores and awareness during end-of-life care. Results Fentanyl equivalent administration in the 24 hours preceding death increased by 309% between epochs. A comparison of survey responses across epochs revealed a significant increase in staff comfort, confidence, preparedness, and awareness when providing end-of-life care. Conclusion The creation of a multidisciplinary quality improvement (QI) team, the implementation of end-of-life guidelines, electronic health record (EHR) modifications, and staff education improved symptom management, staff attitude scores, and awareness when providing end-of-life care.