LAUSR

Background “Out of hospital” (“one way” or “compassionate”) extubations are often offered to or requested by parents of ventilated children on intensive care units to facilitate end of life care away in a different setting. However, there are many reasons why this is not always possible and therefore staff working in intensive care, transport, community and hospice teams may only experience this occasionally. Project description We describe the success of a pilot study day which has run on two occasions. Focusing on a scenario and using actors to play the role of parents, the day is structured using four sections: 1. MDT meeting on intensive care unit where intensive care and palliative care teams discuss futility of intensive care and present options. 2. Second meeting where hospice staff are introduced to the parents and practicalities of extubation in a hospice are discussed. 3. Transport 4. Extubation at the hospice. This is an ambitious and novel teaching method requiring collaboration from different teams. Each section is comprised of a taught session, a scenario and a de-brief. It is a full day and requires participants and faculty from different disciplines from intensive care, transport, palliative care and hospice staff. Results Evaluations of both days, particularly the second day have been excellent. Key learning outcomes include: • Identifying suitable patients • Communication • Advance care and emergency care planning • Practical issues • Symptom management • Referral to other services • Post-death care • Legal issues Conclusions This day is now planned to be offered 2–3 times a year as part of a simulation based palliative care education programme. There is scope to adapt the day to offer teaching to Neonatal or paediatric intensive care staff as well as community nurses/GP’s, with the extubation taking place in a child’s home instead of a hospice.