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Neonatal complex &
palliative careServices & Resources to enhance support for families & staff
Pan London Training Workshop 2015/2016
Alex Mancini
Pan London Lead Nurse for Neonatal Palliative
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Overview
Programme of the day
Handouts-programme,
references & resources
Pre & Post training workshop
questionnaire
Evaluation of the workshop
Resources on NHS London
website
Awaiting CPD
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What does the term palliative care mean to you?
Which babies would be considered as having palliative care
needs?
What difference will palliative care make to the baby and their
family?
Are you offering families all the support which is available to
them?
Are families offered choice in partnership with the team?
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Learning Outcomes Improved understanding of the principles in neonatal palliative care and have
an understanding how to identify babies with palliative care needs
Improved understanding of how to apply those principles and philosophy of
care within an acute critical care setting
Improved understanding of what services and resources are available to
families and how to access them
Improved understanding of collaboration across local services for good
practice
Understand additional resources and services which enhance support for
families whose babies have complex and palliative care needs
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AIM
To reduce inefficiencies in delivering consistent high quality
neonatal palliative care and facilitate smooth care pathways
for each baby and their family
To provide practical support for staff working across
disciplines and develop robust working relationships across
service boundaries
To develop an equitable service across London and
empower families to have choice regarding the care of their
baby
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Link services together to support families
Coordinate care and develop robust pathways
Strategic and advisory role
Support and upscale professionals
Individual neonatal units training workshops
Joint hospice study days
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2010/2011
4 hour workshop
21 Neonatal Units
331 healthcare professionals
Attitudes changed
Increase knowledge
Facilitate access to & utilise a variety of palliative care services
Time constraints/funding
Evaluate the impact
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Neonatal ODN
North Central & East London Neonatal ODN (12)
North West London Neonatal ODN (7)
South London Neonatal ODN (10)
Kings
Lewisham
Royal
Londo
n
Whittington
Northwick
Park
C&W
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Practical Guidance
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Which babies?
• Antenatal diagnosis
• Extreme prematurity
• Birth trauma
• Genetic conditions which are life limiting
• Surgical conditions
• Acute medical conditions
Continuum of care throughout the time of the baby’s life
and beyond
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Diagnosis
Breaking bad news
MDT discussion
Ongoing Care
MDT assessment
Careplan for the whole family
End of Life Care
Advanced care plan
Bereavement support
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Guidance Identify
Eligibility-diagnosis
Consider the family’s wishes
Discuss enhanced support for the whole family
Consider referral to community palliative care team/hospice
Consider where the family would like to be
What is realistic?
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1.Care of the infant
1.1 Discussions with parents
1.2 Pain relief and comfort care
alternative routes for medications-buccal/subcutaneous
non-nutritive sucking, positioning, calm environment and suckling
1.3 Other symptom control-seizures, secretions
1.4 Physiological monitoring-invasive, blood gas
1.5 Fluids & Nutrition-vomiting, reduce total enteral fluid (pg 12)
1.6 Ventilation & Oxygen-practical, discuss possibility that infant may live
1.7 Location of care-joint care-postnatal ward, home, hospice (Pg.14)
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Enhance Neonatal Care
Enhance neonatal care and support for staff
Emotional & practical support for siblings
Community staff support
Access to established community services
Develop continuing relationships for the families with
community teams
Continuing family bereavement support
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Key components Decisions based on the best possible information
Joint decision making with parents,
Open and honest communication throughout
Clear documentation
Individualised integrated care plan with MDT
Continuing care of the mother
Flexible care plan with regular reviews
Parallel planning
Advanced care planning
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Haven House-
Woodford Green
Richard House-
Beckton
Demelza-Kent
https://www.google.com/maps/d/viewer?mid=zvO6tbj1tNpI.k6W-xh0w52nM
NDAU Website
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Bliss Charter Audit Tool
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Donation of breast milk
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Neonatal Organ Donation
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Coffee
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Rainbow Trust28
Child Bereavement UK30
SANDS
• Post Mortem Consent Forms
• Support for families & staff
• Reports & recommendations
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Together for Short Lives
Support
Resources
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Bliss
Family care nurses
Bliss volunteers
Buddy
Support for families & staff
Resources
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TAMBA
Helping Hands
Befriender
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Contact A Family
Information
Support
Resources
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Antenatal Results and Choices(ARC)
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The Lullaby Trust37
The Family Fund
Registered user
Urgent application
Short term
Means tested
Staged payments
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Sibs39
Collaborative Working
• ‘In Reach’
• ‘Out Reach’
• 2 way process
• Knowledge of what services are available
• Sharing good practice
• Maintain relationships
• Named professional
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Additional resource
September 18th
Shooting Star House
October 7th
Haven House
December 2015
Richard House
January 2016
Demelza
Scenario workshop
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Lunch
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Post questionnaire
Workshop evaluation
Maintain relationships
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Training dates
Date Neonatal Unit
July 7th Whittington (NC)
August 14th North Middx (NE)
September 8th Chelsea & Westminster (NW)
September 10th Kingston (SW)
September 17th Lewisham (SE)
October 1st Northwick Park (NW)
October 15th St Thomas (SE)
October 16th West Middx (NW)
October 29th Royal London (NE)
November 12th St Georges (SW)
November 26th UCLH (NC)
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