NICU palliative care

[NICUgalRN]

Our unit is trying to update our palliative care policy and I was just wondering what other units out there are doing. What are the standards once you move to palliative care such as VS, monitoring, and labs? Also, if mom is still in house moving the baby into the room with mom? Do you move the baby to the mother baby unit, if so is the NICU RN only assogned to that infant? Are there units out there that use hospice to send a baby home if that's the wishes of the family? I know this is a touchy subject, but where we work it is unfortunately part of the job description. Just curious to see what other units are doing to maybe help update our policy and give more definitive guidelines.

Thanks for any replies

[NicuGal, MSN, RN]

We use hospice a lot. It depends on the baby and family if the baby goes home or not, many of them are too little. We have tried to have babies moves to mom's room ( the full term kids with a lethal anomaly) but the floor nurses don't want to take responsibility and we can't spare someone to run back and forth. We tried it once and the family kept the nurse tied up (reasonably so) and we had to pick up the rest of the assignment.

Once they are made DNR we continue to follow our routine care protocol with changes as dictated by the DNR order (ie no antibiotics, etc).

[Preemienurse23]

What we do depends on the situation. If it is a kiddo that can go home without ventilation, We send them home on hospice. They can handle a nasal cannula, tube feeds if the family wishes. We usually leave the infant with the parents if it is a lethal anomaly. If the infant is still born the our L&D is fantastic at berevement care. If the parents wish we can bring them down, these are usually the brain anomalies, lethal trisomys that we are not going to resuscitate. In the case of a kiddo already in the unit, if we are withdrawing support they are usually too unstable to transport to moms room. We do have some parent overnight rooms that we use for bereavement if there is a large family present. We use the RTS program and there are a core group of us that will take the palliative kids if we know in advance.