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Implementing bereavement care standards in the community 

In our latest blog, Janet writes about the development of the NBCP in the community, and how collaborating with the local Acute Trust has helped to provide a more joined-up approach to bereavement care in the area. She walks through each of the nine NBCP bereavement care standards and gives practical examples of how these have been implemented. 

I have had the pleasure of leading on the implementation of the National Bereavement Care Pathway (NBCP) Standards in Locala Calderdale PHEYS and Kirklees 0-19 services, and I would like to describe how we achieved compliance with the Standards in a community setting.

The initial mapping of our service provision in Locala showed that we had some gaps in meeting these standards. We have been working together with Calderdale & Huddersfield NHS Trust to implement the recommendations across both community and acute settings.

Collaborating with an acute trust can be quite challenging due to differing priorities, identifying the right people with decision making powers and having them all available at the same time for meetings. On top of this I was implementing the standards during a global pandemic. Technology was changing as we moved to new forms of communication, one example being the acute trust not being able to use Skype for business for meetings and at that time we weren’t able to use Microsoft Teams. Other challenges include different client record systems which don’t communicate with each other.

We started the process by benchmarking ourselves against the 9 Bereavement Care Standards. The midwifery service was already compliant with the ones that were particular to their settings but acknowledged that elsewhere in the hospital the standards would not be fully met. In community we identified several gaps which we would need to address in order to move our service towards compliance with the NBCP standards. Setting priorities was important as was acknowledging the good care we already provided.

It was easiest to do this was by using the standards as a format for the action plan 

  1. A parent-led bereavement care plan needs to be in place for all families, in order to provide continuity between settings and into any subsequent pregnancies

We already had robust communication systems in place between Midwifery, A&E, Paediatricians, SCBU, GPs, Health Visiting and School Nursing and this process has only served to strengthen these links. Depending on the circumstances of the baby death or pregnancy loss, the woman would be offered Consultant Led or Shared Care for any subsequent pregnancies and be able to access the CONI (Care of Next Infant) programme, if appropriate.

It was important to start with the things that could be implemented quickly. I updated the pathway for when we are notified of the loss of a pregnancy or the death of a baby and this was shared with the teams. The next step was to develop a standardised condolence letter that can be sent to a bereaved parent which contains the contact details of organisations and charities who can help provide support. This enables the parent to access a range of support services and be in control of their own bereavement journey, there are also links to organisations who can support existing children with their loss. The letter contains the option of a home visit, if this is deemed appropriate. A Bereavement Postnatal Care and Support Booklet was being developed by the West Yorkshire and Harrogate Health and Care Partnership Local Maternity System (LMS) which is now available to families, so having that as a resource was helpful.

Consulting with practitioners and the SystmOne team I developed a Bereavement Template which now provides a place on the health record to capture the narrative around the baby’s death or pregnancy loss, either at the time of the event or in the years following, because as we know, grief can manifest at different times in our lives, as can having the emotional capacity and/or resource to deal with the death of a baby. A future pregnancy may also trigger grief from a past pregnancy loss. The template enables open and honest communication with parents and facilitates a plan of care based on their wishes. Colleagues are not expected to be experts in bereavement or to provide counselling, just to listen sensitively and record the parent’s story, and if appropriate discuss any further support that may be required. The feedback from parents and practitioners has been very positive, parents really like having a place in their records where not just their grief can be acknowledged but the existence of their baby as well and colleagues feel they now have a dedicated place to record these events and any actions. As always, when you start embedding new processes, it can highlight where else it can be applied; children do sadly pass away and this template has also been used for child deaths over 12 months and for parents who are grieving following the removal of a child for safeguarding reasons, even though their child has not died we can now acknowledge and document the lived experience of these parents.

  1. Bereavement care training. This should be offered to all staff who come into contact with bereaved parents, and they should be supported to access this

The e-Learning for Healthcare Bereavement Training modules ‘caring for people bereaved through pregnancy loss and baby death’  https://www.e-lfh.org.uk/new-e-learning-programme-launched-on-caring-for-people-bereaved-through-pregnancy-loss-and-baby-death/ was made available on ESR and all colleagues were directed to complete this prior to a bespoke training on the NBCP and the new template. The training is now included in the New Starter Training Schedule. As always there is a need to be mindful of colleagues who may have been personally affected by pregnancy or baby loss therefore, a sensitive approach to undertaking this training needs to be adopted. It is important to note that the training should be completed every 3 years to ensure practice is kept up to date.

I continue to liaise with the acute trust to roll out the training offer to staff working in the acute setting, initially targeting A&E, Gynae, Ultrasound Scanning, SCBU and Midwifery. The aim would be for every person the woman meets both clinical and non-clinical to have undertaken the training with the aim of improving care from the first contact with services to the care of the next infant. I provided an update for our GPs via the CCG comms process to share with them the actions we have achieved. They are also able to access the bereavement training modules if they wish to do so.

  1. All bereaved parents are informed about and, if requested, referred for emotional support and for specialist mental health support when needed

There is a CONI team both in Kirklees 0-19 service and in Calderdale PHEYS who are ideally placed to provide direct support to families as well as to practitioners. The bereavement template enables any further actions to be identified from discussion with the family which may include sharing information about charities who provide support specifically around baby death/loss, and/or referral on to specialist bereavement/mental health support services. In Calderdale we also have a Clinical Lead for Perinatal Mental Health who works closely with the Perinatal Mental Health Team and we have a counselling service TalkThru who specialise in pregnancy and baby loss and work with both women and men.

  1. There is a bereavement lead in every healthcare setting where a pregnancy or baby loss may occur

The acute trust already had an identified Bereavement Lead Midwife and as we have a CONI service in both Calderdale and Kirklees it seemed appropriate for them to also be the community Bereavement Leads.

(Standards 5, 6 and 7 are all met by the acute trust)

Provision of Bereavement Rooms are available and accessible across both hospital sites

The preferences of all bereaved families are sought, and all bereaved parents are offered informed choices about decisions relating to their care and the care of their babies

All bereaved parents are offered opportunities to make memories

  1. A system is in place to clearly signal to all health care professionals and staff that a parent has experienced a bereavement to enable continuity of care

This standard provided a bit more of a challenge as we share our records with Primary Care. We managed to overcome this by working closely with the SystmOne team.

We chose a Daisy icon as it is the national symbol for bereavement used across the UK. When the Bereavement Template is completed on a SystmOne record it populates a Daisy icon under the patient demographic box when the record is saved. This signals to any healthcare professional who accesses the health records that the client has experienced the death of a child or the loss of a pregnancy. Parental consent is sought prior to completing the template as the information will be visible to other users for example their GP. Our experience to date shows that they are happy for the information to be shared. By clicking on the Daisy, you can view the details recorded on the Bereavement Template which means it is not lost in the historical content of the records. We acknowledge that not all healthcare providers use SystmOne and understand that other systems are not necessarily visible to all users. However, with IT support, the changes we have implemented in our community setting could be replicated for use with other electronic records, or similar processes adopted. In the midwifery setting they use a similar identification system on the Athena records.

 

  1. Healthcare staff are provided with, and can access, support and resources to deliver high quality bereavement care

The CONI Team have all undertaken the additional bereavement training module and act as a resource for practitioners. There are links on both training modules to charities and organisations who provide specialist support for bereaved families, as does the condolence letter on SystmOne. In addition; the SANDS Bereavement Support App can be downloaded by practitioners and shared with families. We signpost parents and practitioners to The Lullaby Trust and Child Bereavement UK for further bereavement care and support and resources. There are web links to the NBCP Website, and the Lullaby Trust embedded in the Bereavement Template which can be explored with the parent during the contact.

The Bereavement Template gives the health practitioner a framework of care which is specific to pregnancy and baby loss; where identified support needs can be actioned, for example a referral to more specialist support services. Training has been cascaded to all colleagues on how we have met the NBCP Standards- specifically the Introduction to Bereavement Care Training module, the use of the new Bereavement Template and the Daisy Icon. In addition, relevant updates are routinely shared via our weekly emails to provide further information to colleagues.