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Preparing staff for the sudden death of a child in the emergency department

A study day organised by paediatric emergency department sister Tina Fairhead has given staff at her trust the skills and confidence to cope with the sudden death of a child

A study day organised by paediatric emergency department sister Tina Fairhead has given staff at her trust the skills and confidence to cope with the sudden death of a child

  • Other trusts to be invited to study days, with simulations on resuscitation, breaking bad news
  • Safeguarding team, police, mortuary manager collaborated on emergency department guide
  • England has statutory guidance on child deaths but trusts differ in their response
Image shows adult hand holding child’s toy. A paediatric emergency department sister has written Guidelines for the Care and Transfer of the Deceased Child in the Emergency Department and organised Study Days to give staff skills and confidence to cope.
Picture: Alamy

The sudden unexpected death of a child in the emergency department (ED) is a traumatic event, and as healthcare professionals we have a comprehensive range of statutory duties and obligations that we must fulfil when this happens.

In England, statutory guidance is set out in the government document Working Together to Safeguard Children, but trusts differ in their service response. For example, not all hospital trusts are licensed to obtain paediatric post-mortem tissue samples.

However, there is no international expected best practice standard for this.

‘Healthcare professionals say they lack knowledge and confidence to manage the traumatic situation’

In the uncommon event of sudden unexpected death in childhood, healthcare professionals often say they lack the knowledge and confidence to manage the situation, myself included.

To inform and prepare myself, I attended a study day called ‘The day the simulator died’ hosted by Brighton and Sussex University Hospitals NHS Trust. The day included simulations involving resuscitation and breaking bad news, and mini lectures regarding an overview of child death, rapid response meetings and bereavement care.

The event inspired me to develop and host a study day in December 2018 at my own organisation, Dartford and Gravesham NHS Trust, tailored towards our specific requirements.

How to respond effectively

The aim of the day was to provide colleagues with the knowledge and practical experience to effectively respond to the sudden unexpected death of a child in the ED and to introduce agreed guidance for all healthcare professionals to follow. At the time, the trust had no evidence-based guidance for nurses to follow.

The guidance, Guidelines for the Care and Transfer of the Deceased Child in the Emergency Department, was written by me in collaboration with the trust’s mortuary manager, safeguarding team and the local police (see box).

Guidelines for the Care and Transfer of the Deceased Child in the Emergency Department

The guidelines cover:

  • Responsibilities of staff at all levels
  • What to do when a child has been pronounced dead
  • Communication with parents and family
  • Spiritual and religious support
  • Procedure after death
  • Care after death
  • Infection control
  • Transferring the child to the mortuary
  • Organ donation
  • Staff support
  • Further reading

Note: For more information about the guidelines please contact the author at Tinafairhead@nhs.net

It was agreed at trust level and published on the hospital intranet, where it is available to all trust staff.

Resuscitation and communication skills

Working alongside the trust’s education and simulation department, in the study day we included simulations and seminars, providing opportunities for attendees to practise resuscitation and communication skills and have open discussions in a classroom environment.

Topics for the day were chosen following informal discussions with nursing colleagues in the paediatric ED.

No funding was needed for the event, which was held on trust premises at Darent Valley Hospital, as speakers gave up their own time to attend.

Image shows adult looking sad in child’s room. A paediatric emergency department sister has written Guidelines for the Care and Transfer of the Deceased Child in the Emergency Department and arranged Study Days to give staff skills and confidence to cope.
Picture: iStock

The programme included an overview of unexpected child death, a discussion about child deaths in our area, and information from the safeguarding children guidance.

Before the exercises, attendees were given an introduction to simulation to ensure personal safety. The exercises covered an unsuccessful resuscitation attempt and breaking bad news; and each scenario was followed with a debrief.

Seminars were presented by police officers and the mortuary manager, providing information about the expectations of the coroner and what duties, regulatory protocols and procedures are expected following an unexpected child death.

Visit to mortuary

A visit to the mortuary was included in the programme as this was identified as an area that healthcare professionals said they had little knowledge of.

The day was advertised by word of mouth and through networking with colleagues from relevant agencies, including the training lead for the ambulance service, police and ED staff involved in a sudden unexpected child death response.

Participants were initially limited to 12 to allow everyone to participate actively. However, this was increased to 22 because there was so much interest from staff wanting to attend the event. The participants included emergency nurses, nursing students, doctors, healthcare assistants, paramedics and ambulance technicians and police.

Attendees were sent the programme by email and given necessary information before the study day. All participants were requested to attend the day in their professional uniform to ensure they were identifiable during simulations. This also helped to make simulations feel more realistic for participants.

‘Participants attend in uniform, making the simulations feel more realistic’

All attendees were asked to evaluate the day to determine whether it had been a useful and effective learning opportunity, and all responded. Feedback was overwhelmingly positive – attendees reported finding the day informative and having a greater understanding of each other’s roles following a sudden unexpected child death after attending the study day.

Sudden unexpected death in childhood

Sudden unexpected death in childhood

Schedule for study day:

  • 08:45 – Registration
  • 09:00 – Welcome and introduction, putting the day into context
  • 09:30 – Resuscitation simulation
  • 10:30 – Debrief simulation
  • 11:00 – Breaking bad news simulation
  • 11:30 – Debrief simulation
  • 12:00 – Lunch
  • 13:00 – Child death overview process police officer seminar
  • 13:45 – Mortuary manager seminar + mortuary visit
  • 15:00 – Care of deceased child seminar
  • 15:45 – Evaluation and conclusion
  • 16:00 - Home

Respondents also reported that the breaking bad news scenario was invaluable, with many saying the simulation was the first time they had been involved in informing a parent about the death of a child.

Ideas, concerns, expectations

Participants said they welcomed the opportunity to discuss a sensitive subject in a safe environment, expressing ideas, concerns and expectations. Participants from the ambulance service expressed a wish for more simulation scenarios involving them, which will be added in future study days.

Police officers attending the study day said they had been unaware of the ED’s response in relation to resuscitation and that the day had enabled them to put an unexpected child death into context from the moment resuscitation was stopped.

They recognised the importance of knowing the whole journey a child and family go through from the initial 999 call to entering the ED, and have included our study day in their own training programme.

Different grief responses

After the first study day we decided to include a resuscitation update before starting the resuscitation simulation, as the feedback indicated that not all participants understood how to follow the Resuscitation Council's paediatric advanced life support algorithm, and it gave a useful refresher of or introduction to the process for all staff.

Due to the success of the study day, a second event has been held, and more are planned for later this year and 2020. A pre-hospital simulation session will be included, and the breaking bad news session will be extended to cover different grief responses. Staff from other trusts will be invited to attend next year’s events.

The sudden unexpected death of a child is an event rarely witnessed in the ED, but it is an emotive scenario for all healthcare professionals involved. It is also important for healthcare professionals to appreciate that at the heart of this are the parents, who have suffered the most unimaginable bereavement, the death of a child.

Sensitive, appropriate response

To ensure nurses and other healthcare staff respond in a sensitive and appropriate way that adheres to statutory guidance, nurse leaders must ensure that staff are equipped to provide relevant and timely support and information to families and other professionals who may find themselves involved in such an event.

The study day will continue to provide participants with the knowledge and skills to respond compassionately and sensitively while fulfilling their statutory and professional obligations.


Tina Fairhead is a paediatric emergency department sister at Dartford and Gravesham NHS Trust, Dartford, Kent.

 

 

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