Never Alone
Perinatal Palliative Care Program
Eileen Ludden, BSN, RNC –OB C-EFM
Director Labor and Delivery
Nancy Wood, BSN, RNC-OB, C-EFM , CDE
Director High Risk Perinatal Center
Holy Cross Hospital
Silver Spring, Maryland, 20910
S
Mission
S To be the most trusted healthcare provider in the
area
S To serve patients and their families who elect to
carry a pregnancy to delivery in which a poor
outcome is expected
Prenatal Diagnosis
Exists when a pregnant woman is determined
to have a life-threatening or serious illness or
when her unborn fetus is anticipated to be
born with a life-limiting birth defect that will
likely result in a neonatal death.
Birth Defects
S In the U.S. up to 20,000 infants are born
annually with conditions that are considered
incompatible with life beyond the first year
S In the State of Maryland 1 in 6 births result
in a birth defect
What is Palliative Care?
S Model of care that is holistic and extensive specifically for a patient
who is not expected to “get better”
S Planned intervention by trained interdisciplinary staff members who
support the family and deliver care in an empathetic and sensitive
manner
S Goal is to prevent and relieve physical pain and suffering of the
patient and to improve the conditions of living and dying
S Focus is on the family as a unit, on preserving the dignity of life and
helping to memorialize whatever brief time they may have together
S A team approach to alleviate physical, psychological, social,
emotional, and spiritual suffering
Potential vs. Actual Referrals
Of the forty patients in FY10 who were
potential referrals to this program, zero
referrals were received
Problem Statement
Patients with a prenatal diagnosis, medical
staff, nursing staff and the community were
not aware of the Perinatal Palliative Care
Program
Goal
To educate the medical and nursing staff and
community about the existence of the Never
Alone Perinatal Palliative Care Program
Why does this matter?
S With advanced planning, patient’s wishes for
their delivery and the care of their baby are
addressed
S Decreases stress on the patient, family, and
staff
S Staff is better able to support the family
when there is a plan of care
Process Metrics & Baseline Measures
S Number of referrals
S Pre & post implementation knowledge surveys
S Zero referrals in Fiscal Year 2010
S A pre-implementation survey of the medical
and nursing staff indicated only 33% had any
knowledge of the existing Perinatal Palliative
Care Program
Pre-Implementation Knowledge
Survey – December 2010
Are you aware of the Perinatal Palliative Care
Program?
67%
Yes
33%
No
Identified Problems
S Knowledge deficit
S No single phone number to call to
enter patient into program
S No intake sheet to get information
regarding patient’s diagnosis
S No marketing of the program
Action Plan
After survey results were reviewed, education
opportunities were provided
S OB/GYN Dept. Meeting
S Staff Meetings
S Fact sheet for physician offices
S Brochure for patients and physician
offices
S Community Outreach-Isaiah’s Promise
and Archdiocese of Washington, DC
Summary of Improvement
S Identity of the program occurred through name recognition
S Education-staff meetings & department meetings
S Development & Implementation
S Patient brochure
S Fact sheet for the physicians
S Intake Information Sheet
S A sample birth plan
S Re-educate on the Perinatal Alerts Binder
S Community Outreach-Isaiah’s Promise, Archdiocese of
Washington, DC
Post Implementation Survey
Are you aware of the Never Alone
Perinatal Palliative Care Program?
18%
82%
Yes
No
The Never Alone Program is not
about Finances
S Revenue to HCH for a routine Mother Baby stay of 2-3
days averages $5,000 for the mother and $1,000 for the
baby
S Revenue for a NICU 5 day stay averages $8,800
S “Revenue” or potential benefit to the patient who has the
support of the Never Alone program is PRICELESS!!!
S Families will partner with us for their future health care
needs and may refer others to us because of the care
and support that they received
Challenges
S Large number of physician groups and
multidisciplinary staff to educate about
program
S Communication of patient’s plan of care to
their physician, neonatology and nursing
departments
S Program Identity
Change Management
S Marketing-competing agendas with other
areas of the hospital and the new hospital
S Develop relationships with other
departments and the community
S It is not easy!!! Make sure you communicate
effectively
Lessons Learned
S Communication is vital to the success of any
program
S Increased knowledge base in regards to the
development of a brochure
S Importance of “branding” and name
recognition
S Be prepared for the plan of care to change
Miles Emmanuel
April 23, 2011- April 24, 2011
But Jesus called them to him, saying,
“Let the children come to me, and do not hinder them,
for to such belongs the kingdom of God.” –Luke 18:16