Utility of Morbidity and Mortality Conference in End-of-Life Education in the Neonatal Intensive Care Unit

Abstract

Background: A monthly neonatal intensive care unit (NICU) morbidity and mortality conference (M&MC) was used to study the documentation of end-of-life (EOL) care, and integrate related education for staff and trainees. Objective: To study the current documentation of comprehensive, interdisciplinary, palliative EOL care in the NICU at the Vanderbilt Children’s Hospital and improve it relative to a historical background. Design/Methods: A survey tool was developed and used at all neonatal M&MCs for 1 year (August 2003 through July 2004), in conducting a prospective chart audit of 50% of NICU deaths. The survey ascertained documentation of EOL care to include the anticipation of death by family and staff; provision of pain management; discussion of ethical and EOL decision-making issues; and the use of supportive services. Clinical education and literature references pertaining to these elements of care were presented in the conferences. Results: Twenty-six surveys were completed (48% of deaths in NICU over the study period). Documentation of EOL care ranged from excellent (pain management, 100%) to poor (spiritual support, 54%). Documentation of all other measures varied from 69% to 92%. Staff and trainees reported educational enhancement of the M&MC, and greater awareness of issues important to EOL care throughout this period. Conclusions: Areas for improving EOL care exist in the NICU. The M&MC is a familiar venue for incorporating EOL care education for staff and trainees. A survey tool may serve to aid in the assessment of documentation of such care. Staff awareness of, and attention to, EOL issues may be improved through such a mechanism.