| Learning Objective #1: Describe circumstances surrounding deaths of hospitalized children | |||
| Learning Objective #2: Identify strategies to improve pain and symptom management at hospitalized children's end of life |
Objective: Pain and symptom management is an integral part of pediatric palliative care, but little is known about end-of-life care of children. We sought to describe the circumstances surrounding the deaths of terminally ill hospitalized children, especially as they pertain to pain and symptom management by the multidisciplinary pediatric care team.
Design: Retrospective medical record review
Sample: 105 children (aged 1 day-19 years) who died at Vanderbilt Children's Hospital between July, 2000-June, 2001.
Variables: End-of-life management, pain and symptom management, family and child ancillary support
Methods: An automated search of computerized records was used to identify all eligible patients. A chart review was completed using an extraction tool adapted from templates used by the City of Hope, Dana-Farber Cancer Institute, and Medical University of South Carolina.
Findings: Although death was documented as an expected outcome in 23% of patients, only 2% were considered for hospice referral. DNR orders were written for 42% of patients, CPR was provided in 45%, and 64% of deaths occurred after the withdrawal of artificial life support. Only 26% of patients received a bolus of pain medication and 3% received neuromuscular blocking agents at the time of removing life support. While nearly all children had nutritional support initiated, 23% had it withdrawn prior to their death. 96% of patients had major diagnostic and/or imaging tests performed within 48 hours of their dying. 90% of children received pain medication in the last 72 hrs of life, and 55% received additional comfort care measures. Few children received ancillary services.
Conclusions: Although the duration of hospitalization for most children dying in our inpatient setting is sufficient to provide palliative care, many eligible patients did not receive such services.
Implications: Findings emphasize importance of exploring initiatives to improve end-of-life care of hospitalized children through practice, research, and education.
Back to Critically Ill Child
Back to 14th International Nursing Research Congress
Sigma Theta Tau International
10-12 July 2003