Neonatal Death - what does your unit do?

danissa, LPN, LVN · Sep 17, 2007

We ask other parents to leave for a while if a wee baby is dying, also during a code, its better that other parents are not present. i guess our intensive care area is like yours, we also have to use screens between the bays. But mostly, other families will leave the unit when we need them to.

One particularly bad exception, was when we had a dying baby in one bay, all the family in to say goodbye, and no-where else to move that baby to, as our quiet room was full already. In the next bay, was a poor wee guy, up for adoption, with parents on the missing list. They NEVER showed their faces until that afternoon when the poor family next to them were saying goodbye to their precious baby. turned up absolutely drunk and stinking, the smell was so bad that one of my co-workers vomited. Worst thing was, we had to keep them there until Police and social services arrived, as they were wanted for multiple stuff by both agencies. mental abuse to the family that were grieving..yes! Sticks in my mind to this day, but, we had to try to keep them in the unit, and the situation was terrible.

Aside from that one awful incident, yes, respect is given to the families of the infant who is dying/coding. Sometimes you feel like its all you can do for them, to give them privacy to mourn the loss. And if a baby is coding...you absolutely dont need other parents around to witness the drama.

hikernurse · Sep 18, 2007

We have parents of the other babies leave. Mostly for privacy for the family, but partly, I think, for HIPAA and to give the staff room to work.

We do have a few family rooms that we use; the families can take their baby in there and there is no limit on how many can visit in that instance, as long as the parents want them there.

EricJRN, MSN, RN · Sep 18, 2007

Depends on the situation for us. We're an open unit, but divided somewhat into pods. We might close a pod to visitors during a code and utilize privacy screens.

For postmortem care, we try to see if there is an isolation room or nesting suite where we can move the baby, so that the families can come and go and have privacy.

BittyBabyGrower, MSN, RN · Sep 18, 2007

We have the families of the other babies leave. If their baby is able to, we will let them take it to the breastfeeding room. We then put screens up around the grieving family and close the doors to the pod.

LilPeanut, MSN, RN, NP · Sep 20, 2007

I've never seen other families asked to leave on my unit. We're separated by curtains and in pods. If it's withdrawing support, we try to have an isolation room, parent room or conference room for them to use to say goodbye, but that's not always possible.

The other families know what it means when there are 10 million people around a bedside and the curtains get drawn. They all stay out of the way. Most of them are probably just thanking God it's not their child that night. Nurses who aren't involved in the code and whose pts. have families do therapeutic communication and teaching if the family has questions or concerns.

justme1972 · Sep 20, 2007

When my children were in the NICU, when something major like a code or a death happened, the nurses quickly asked everyone to step out of the unit. It was a large NICU, so this was quite a few people in the hallway.

I'm a student, but just from a parent's viewpoint, you do watch other babies when you come in and you celebrate with the other parents when their children reach milestones. However, it is also incredibly heartbreaking to watch something horrible happen to a baby, because the first thing you are doing....is comparing it to yours and wonder if yours is next.

I personally believed "clearing" the unit was the right way to handle it.

Love_2_Learn · Sep 20, 2007

Ours is an open unit as well. We gently ask our parents to leave when there is a code, a baby dying, or a very sick baby admission.

During our admission teaching we go ahead and give anticipatory guidence for this. We mention that we encourage parents to visit any time except when we are closed for rounds/shift change and that the only other time they may be asked to leave or not visit would be if there were an especially sick baby needing the full attention of our nursing and medical team. "Like when your baby was born, we focused our attention on your little one for that first hour or so." We tell them that usually the unit will not be closed for very long during such times. They always nod their head yes and I've not heard of a complaint about this general policy.

As soon as a baby passes and the parents have had a few mintues to cuddle, we assist them to move to our "quiet room" for privacy and to spend as much time with their baby as they wish. This is where post-mortem care is done. It is when the family is moved to the quiet room that we allow visitors to re-enter.

The only complaint about this policy that I know of was once when a mother was arriving to breast feed her baby and it meant so very much to her to do so; we took her and her baby to the breast feeding room and that worked out fine.

I think it could be pretty upsetting for parents to be near when a baby is dying; I have to wonder if they are imagining if their own baby will not survive either... things like that.

MegNeoNurse · Sep 22, 2007

Thank you all very much for you feedback. I plan to bring many of these suggestions to our next unit meeting. Hopefully our staff can come to an agreement on what to do, as a few of our staff members have experienced having a child in the NICU and can bring that point of view to the table as well.

kitty29 · Sep 23, 2007

Hi all. Just curious as to what your unit does in the event of a death? Do you have all visitors (including family) of other patients leave? What about codes?
I am asking because we currently have one large unit with individual bedsides, we put up "privacy" curtains during removal from life support but do not ask other patients' visitors to leave, same in the event of a code.
I had a mother of another patient come up to me very upset about what was going on at the bedside right next to her baby's, almost in tears seeing family members of the other baby coming out from behind the curtains bawling, and NILMDTS photog was there taking pics, etc. Bad bad situation and I absolutely understand that mother being upset. I would not want to hear/see another infant's family going through that child's death while my own child is very sick and in the NICU.
Just curious as to what other units do, would like some feedback before I bring anything up at a unit meeting or to our coordinator. Thanks in advance for any responses.

If I could figure out how to do an attachment I would send you specifically what we do...I wrote it up a couple of years ago; and update it yearly.

Updated NEONATAL INTENSIVE CARE BEREAVEMENT SERVICES.doc

kitty29 · Sep 23, 2007

Maybe I did figure it out?

kitty29 · Sep 23, 2007

If I could figure out how to do an attachment I would send you specifically what we do...I wrote it up a couple of years ago; and update it yearly.

Ok now I'll add the check list...maybe...If I can do this twice, I'll mail what I know/have.

Updated Newborn Infant Loss Referral.doc

Updated NICU Infant Loss Check List.doc

Cards Used In NICU Bereavement Program.doc