Neonatal Death - what does your unit do?

[MegNeoNurse]

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.

[travelingkind]

We ask other guests/visitors of other babies in our unit to leave if there is a death, code, surgery, and sometimes even for a sick admission. I actually integrate that as part of my orientation to new arrivals in the NICU and tell the families that to respect the privacy of other patients, we will ask them to step out in serious situations. I explain that they would want the same privacy if it was their family going through something difficult. Even after evacuating the other visitors, we still put curtains up around the situation so those famliy members aren't disturbed by the natural going's on in the unit.

As soon as possible, we move the grieving family into a private room, allowing the other visitors back in the unit.

I think it is imperative that families maintain their privacy and dignity as much as possible when a code or death is happening. When other families have not been asked to step out, it has often been disturbing for them. (sometimes the nursing staff is so focused on the situation that no-one asked them to leave.) If it were your familiy member dying, you would want the same privacy.

[elizabells, BSN, RN]

We generally ask parents to step out - we have 2-3 baby pods on our 60 bed unit. Very, very rarely a parent will refuse and we pull the privacy curtains. Last week had a bit of a situation with a mom of a room-air feeder insisting she stay in the pod during a full (unsuccessful) code (compressions, epi, etc) because her baby was just as sick as the one we were coding. I get that it's all a matter of perspective, but there's just no reasoning with some folks. Usually what happens is the parents of the baby who is passing will go to one of our lactation rooms (or several other private family conference rooms) and we'll bring the baby to them.

[wensday, MSN, RN, APN, NP]

It sounds like most NICUs do the same as us, we ask other parents to leave the room for sick admissions/resus (you lot call it a code) that requires ECM-drugs etc/ward rounds/withdrawing care/baptism (but depends on the situation).

We always ask the parents if they would prefer to hold the baby at the incubator before/after the ETT is removed, or take the baby vented to the quiet room (that's a big, comfy, private room) or for them to wait in the quiet room and we can whip the tube out and run round to the room. Everyone has a different way they want to do it and it depends on what else is going on in the room at the time. It's horrible to extubate and run in the middle of visiting time.

Then they can spend as much time as they need, we have 2 overnight rooms and a special bath and moses basket and nice clothes. They can take the baby home too if they want. The parents tend to already be in the overnight rooms cos if the baby is that sick they can stay on the unit- depending on space. We've recently got 4 flats as well just next to the hospital for sick baby parents or those that are from a long way- we are a very big NICU.

Hmmm, it's sad but I still love my job. I like knowing that the baby has had the best end-of-life I could possibly give to the baby and the family.