39\u2005Family presence on the HDU ward round: balancing compassionate care with patient privacy and confidentiality

Abstract

Background The paediatric cardiology HDU ward can be a busy environment with complex and often very unwell children. Ward rounds are imperative for information sharing and complex decision-making, but have traditionally been run without parental presence to maintain patient confidentiality. Parents were asked to leave their children creating problems twofold; both child and parent would be distressed at not being with the other when the child is often critically unwell, and parents would have to track down doctors for clinical updates and management plans. We proposed the use of noise-cancelling headphones for use during the ward round to maintain confidentiality, whilst keeping parents by their child’s bedside. Objectives To understand and evaluate the current HDU parental experience. To implement a strategy to improve the HDU experience. To evaluate the change. Methods Two questionnaires were constructed to collect retrospective and prospective data. Telephone discussions with parents of children who were admitted during July-August 2019 took place to answer the questionnaire before the implementation of headphones. Anonymised paper questionnaires were given to parents of children admitted during September-October 2019, when headphones were being used. Headphones were given to all parents present in HDU to be worn at all times, apart from when their child was being reviewed so they could contribute. Doctors and nurses on the cardiology ward were also given a questionnaire for their opinions about how headphones have altered working practice. Results Prior to implementation, all parents were asked to leave ward round at some point during admission (100%, n=7). After headphone implementation, 90% of parents were invited to stay (n=12). Parents were most thankful for the support they were able to provide for their child constantly during ward round, and the ease at which they were able to gather information from the medical team about their childs’ progress so far and subsequent plans. Staff results mirrored parental responses, indicating enhanced confidentiality and parental inclusion in ward round discussions were key positive factors following implementation. Conclusions Implementing headphones enabled parents to engage with ward rounds. In a busy environment with complex and unwell children, we should do our utmost to reduce patient and parental anxiety, and help empower parents in challenging times. This holistic approach is imperative to a positive patient journey and good rounded compassionate care.