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Current Pediatric Research| Volume: 22
November 28-29, 2018 | Dubai, UAE
15
th
World Congress on
Pediatrics, Clinical Pediatrics and Nutrition
28
th
International Conference on
Nursing Practice
Joint Event
&
Dignity in Death- Shared Decision making and promoting realistic Medicine
Amani Arthur
Evelina London’s Children Hospital, UK
Introduction:
Shared decision making and respecting patients/
parentswishes regardingdirectionof careandmore importantly
‘place of care’ is a key concept of realistic medicine. Admission
to a paediatric intensive care unit is often both aggressive and
invasive, with an aim for restorative therapy. Despite this, there
is inevitably a small cohort of patients where re-orientation
of care becomes most appropriate and withdrawing invasive
treatment is in their best interest. The practice of reorientation
of care has evolved through the years and involves close
collaboration with a multidisciplinary team and with parents.
Objectives:
To reviewcurrent literature regarding re-orientation
of care at home for children at the end of life, with an aim to
develop a local guideline for implementation and practice for
our local PICU.
Methods:
An initial literature search was performed to
identify UK current practice of re-orientation of care and
acknowledgement of any existing guidance. A retrospective
analysis of deaths that occurred in our critical care unit from
2010-2017 and identification of those who may have been
applicable for re-orientation of care out-with the critical care
environment was done. Thereafter, in collaboration with
the paediatric palliative care team, a guideline and discharge
checklist to implement in clinical practice was introduced.
Results:
Between 2010 and 2017, throughout our hospital, 18
children utilised a service to allow death out-with the hospital
setting; 15 had a haematological or oncological diagnosis, and
3 had a non-malignant diagnosis. Within the critical care unit,
there were 76 deaths, 28 of these (37%) were identified as
appropriate for re-orientation of care out-with the critical care
environment; around 3 per year.
e:
amani.khader89@gmail.comPediatrics and Clinical Pediatrics 2018
& Nursing Practice 2018, Volume 22
DOI: 10.4066/0971-9032-C2-006