**10. The multidisciplinary team**

Palliative care in PICU is delivered by a multidisciplinary team in an effort to provide a holistic approach to address the needs of the child and their family. In addition to PICU medical and nursing staff, the team ideally includes the following staff members:

• *Physiotherapy*:

The physiotherapist facilitates interventions such as therapeutic massage, passive movements and positioning. They provide education for the family and carers regarding patient transfers and respiratory care.

• *Psychology*:

A clinical psychologist can assess and assist in the management of emotional or behavioural disturbances in the child.

• *Complementary therapist*:

Therapies such as, aromatherapy, massage, music and reflexology may improve the patient's quality of life or psychological wellbeing [61].

• *Pastoral care*:

Involvement of the local pastoral care team can provide spiritual and religious support for family and staff caring for a child with life-limiting or terminal illness. Some families may wish to have their own faith leader present on PICU.

• *Social workers*:

Medical social workers are key support for the parents. They will assist the family with planning, finances and minimising the impact on the patient's siblings. Some parents have difficulty accepting the need for palliative care for their child [36] and social work can refer them for specific psychological or bereavement support.

As aforementioned, routine meetings between the family and the interdisciplinary team should provide the family with consistent communication about the child's clinical condition and agree upon treatment goals. All team members are provided with an opportunity to discuss the patient and support the medical team and family with difficult decision-making.

## **11. Audit, quality assurance and follow-up**

A focus on audit and quality improvement is key to the delivery of high-quality palliative care in PICU. There are many evidence-based guidelines [62] which specify standards for provision of a comprehensive paediatric palliative care service. Undertaking audit against such guidelines is essential to gauge whether care is adequate and also provides the impetus to develop local quality improvement plans.

Another simple means of assessing a unit's performance is to conduct surveys amongst both the PICU staff and parents. This will identify areas that need to be improved upon and inform local research.

It is important that the institution recognises the need to educate care providers regarding palliative care practices. Education may take place in the form of multidisciplinary teaching sessions, provision of online resources or provision of funding for staff to gain additional qualifications such as a diploma or masters in palliative care.

Development of an integrated care pathway for palliative care in PICU will provide guidance for staff. All members of the multidisciplinary team should have input in the creation of such a document. It should function as a guide in the delivery of palliative care but recognise the importance of individual patient needs.

As aforementioned, in our institution we meet with bereaved parents in the months following a child's death. We also have an ethical duty to support our staff who can be left with a profound emotional impact from caring for a dying child. A helpful means of debriefing is the 'Schwartz Round', where the multidisciplinary team can discuss the emotional impact of their work [63]. This enables staff to support each other and can strengthen relationships within the team.

#### **12. Conclusions**

Palliative care in PICU can be a complex process. Paediatric patients may require palliative care for a variety of reasons and interventions should be tailored to each specific patient. The goals of care are to enhance quality of life and relieve suffering of patients and their families.

Ideally the patient, family and multidisciplinary team will form a shared plan to guide their palliative care journey. Regular family conferences should take place to continue this collaborative process and build relationships between the family and caregivers.

Processes such as redirection of care, withdrawal of life-sustaining therapies and organ donation should be approached by the team with sensitivity and compassion.

As not all children will have an advance care plan, the PICU team need to be equipped to deliver end of life care and guidance should be in place to facilitate this. Regular audit of outcomes should guide quality improvement in palliative care practices in the PICU.

**25**

**Author details**

and Suzanne Crowe\*

*Palliative Care of the Infant and Child in the Paediatric Intensive Care Unit*

No external funds were sought or obtained for the preparation of this

Maeve McAllister, Ann-Marie Crowe, Roisin Ni Charra, Julie Edwards

Children's Health Ireland at Crumlin, Dublin, Ireland

provided the original work is properly cited.

\*Address all correspondence to: suzanne.crowe@olchc.ie

Department of Paediatric Intensive Care Medicine, Paediatric Intensive Care Unit,

© 2021 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

*DOI: http://dx.doi.org/10.5772/intechopen.97275*

The authors declare no conflict of interest.

PICU Paediatric Intensive Care Unit CBT Cognitive Behavioural Therapy

ECLS Extra Corporeal Life Support

ECMO Extra Corporeal Membrane Oxygenation

ACP Advance Care Plan

**Acknowledgements**

**Conflict of interest**

**Abbreviations**

manuscript.

*Palliative Care of the Infant and Child in the Paediatric Intensive Care Unit DOI: http://dx.doi.org/10.5772/intechopen.97275*
